Heights University Hospital

All Charges

Charge

Type

Setting

Price

STERILE GOWN SIZE LARGE

Facility

$12.50

Hospital Charge Code	270653946
Hospital Revenue Code	270
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

STERILE O.R. TOWELS

Facility

$280.55

Hospital Charge Code	270653367
Hospital Revenue Code	272
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$42.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.08

STERILE O.R. TOWELS

Facility

$280.55

Hospital Charge Code	270653367
Hospital Revenue Code	272
Min. Negotiated Rate	$36.47
Max. Negotiated Rate	$140.28
Rate for Payer: Aetna Commercial	$84.17
Rate for Payer: Aetna Medicare Advantage	$84.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.54
Rate for Payer: Cigna Commercial	$140.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.47
Rate for Payer: Oxford Commercial	$140.28
Rate for Payer: Qualcare PPO/HMO/WC	$42.08
Rate for Payer: UnitedHealthcare Commercial	$140.28

STERILE TALC #1680 *****

Facility

$110.00

Hospital Charge Code	1606268
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

STERILE TALC #1680 *****

Facility

$110.00

Hospital Charge Code	1606268
Hospital Revenue Code	272
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

STERILE TALC 4 GM AEROSOL

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	6063943270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.63
Max. Negotiated Rate	$56.28
Rate for Payer: Aetna Commercial	$33.77
Rate for Payer: Aetna Medicare Advantage	$33.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.70
Rate for Payer: Cigna Commercial	$56.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.63
Rate for Payer: Oxford Commercial	$56.28
Rate for Payer: Qualcare PPO/HMO/WC	$16.88
Rate for Payer: UnitedHealthcare Commercial	$56.28

STERILE TALC 4 GM AEROSOL

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	6063943270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

STERILE TALC POWDER

Facility

$490.00

Hospital Charge Code	60635774
Hospital Revenue Code	250
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$147.00
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$245.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Commercial	$245.00

STERILE TALC POWDER

Facility

$490.00

Hospital Charge Code	60635774
Hospital Revenue Code	250
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$73.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

STERILE TALC POWDER 5GM

Facility

$97.00

Hospital Charge Code	60635168
Hospital Revenue Code	250
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

STERILE TALC POWDER 5GM

Facility

$97.00

Hospital Charge Code	60635168
Hospital Revenue Code	250
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$29.10
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.61
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$48.50

STERILE WATER 1000 ML

Facility

$9.51

Hospital Charge Code	270600659
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.43
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$4.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$4.75

STERILE WATER 1000 ML

Facility

$9.51

Hospital Charge Code	270600659
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

STERILE WATER 20ML

Facility

$4.00

Hospital Charge Code	6022859
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

STERILE WATER 20ML

Facility

$4.00

Hospital Charge Code	6022859
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

STERILE WATER 20 ML INJ

Facility

$20.00

Hospital Charge Code	60628550R
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

STERILE WATER 20 ML INJ

Facility

$6.10

Service Code	NDC 409488720
Hospital Charge Code	60628550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare Advantage	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.56
Rate for Payer: Cigna Commercial	$3.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Oxford Commercial	$3.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$3.05

STERILE WATER 20 ML INJ

Facility

$20.00

Hospital Charge Code	60628550R
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$10.00

STERILE WATER 20 ML INJ

Facility

$6.10

Service Code	NDC 409488720
Hospital Charge Code	60628550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

STERILE WATER - 2L IV BAG

Facility

$72.00

Hospital Charge Code	60628552
Hospital Revenue Code	636
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

STERILE WATER - 2L IV BAG

Facility

$72.00

Hospital Charge Code	60628552
Hospital Revenue Code	636
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$17.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

STERILE WATER 50ML INJ

Facility

$28.54

Service Code	NDC 409488799
Hospital Charge Code	60628551
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$14.27
Rate for Payer: Aetna Commercial	$8.56
Rate for Payer: Aetna Medicare Advantage	$8.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.28
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.71
Rate for Payer: Oxford Commercial	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$14.27

STERILE WATER 50ML INJ

Facility

$28.54

Service Code	NDC 409488799
Hospital Charge Code	60628551
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.28

STERILE WATER FOR INHALATION 2

Facility

$16.46

Hospital Charge Code	270655450
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

STERILE WATER FOR INHALATION 2

Facility

$16.46

Hospital Charge Code	270655450
Hospital Revenue Code	270
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.23
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$8.23

Know your out-of-pocket cost for care.

All Charges