Heights University Hospital

All Charges

Charge

Type

Setting

Price

STOMA FLEX WAFER 1 3/4

Facility

$27.25

Hospital Charge Code	270303145
Hospital Revenue Code	272
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.54
Rate for Payer: Oxford Commercial	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$13.62

STOMA FLEX WAFER 1 3/4

Facility

$27.25

Hospital Charge Code	270303145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

STOMA FLEX WAFER 2 3/4

Facility

$29.65

Hospital Charge Code	270303150
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

STOMA FLEX WAFER 2 3/4

Facility

$29.65

Hospital Charge Code	270303150
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

STOMAHESIVE 1.5 2.75 BX *****

Facility

$32.00

Hospital Charge Code	8004426
Hospital Revenue Code	279
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

STOMAHESIVE 1.5 2.75 BX *****

Facility

$32.00

Hospital Charge Code	8004426
Hospital Revenue Code	279
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

STOMAHESIVE 4 BX *********

Facility

$174.00

Hospital Charge Code	8001414
Hospital Revenue Code	279
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

STOMAHESIVE 4 BX *********

Facility

$174.00

Hospital Charge Code	8001414
Hospital Revenue Code	279
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$87.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$87.00

STOMAHESIVE 4X4 021712

Facility

$28.85

Hospital Charge Code	270649015
Hospital Revenue Code	270
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.33

STOMAHESIVE 4X4 021712

Facility

$28.85

Hospital Charge Code	270649015
Hospital Revenue Code	270
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$14.43
Rate for Payer: Aetna Commercial	$8.65
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.36
Rate for Payer: Cigna Commercial	$14.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.75
Rate for Payer: Oxford Commercial	$14.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.33
Rate for Payer: UnitedHealthcare Commercial	$14.43

STOMAHESIVE POWDER 1OZ

Facility

$18.00

Hospital Charge Code	270649016
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

STOMAHESIVE POWDER 1OZ

Facility

$18.00

Hospital Charge Code	270649016
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

STOMATE FLEXIFLO***

Facility

$444.00

Hospital Charge Code	2300754
Hospital Revenue Code	279
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$133.20
Rate for Payer: Aetna Medicare Advantage	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.22
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.72
Rate for Payer: Oxford Commercial	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.60
Rate for Payer: UnitedHealthcare Commercial	$222.00

STOMATE FLEXIFLO***

Facility

$444.00

Hospital Charge Code	2300754
Hospital Revenue Code	279
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.60

STOMATE FLXFLO LRG 22FR 50100

Facility

$1,001.65

Hospital Charge Code	270611261
Hospital Revenue Code	270
Min. Negotiated Rate	$130.21
Max. Negotiated Rate	$500.82
Rate for Payer: Aetna Commercial	$300.50
Rate for Payer: Aetna Medicare Advantage	$300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.42
Rate for Payer: Cigna Commercial	$500.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.21
Rate for Payer: Oxford Commercial	$500.82
Rate for Payer: Qualcare PPO/HMO/WC	$150.25
Rate for Payer: UnitedHealthcare Commercial	$500.82

STOMATE FLXFLO LRG 22FR 50100

Facility

$1,001.65

Hospital Charge Code	270611261
Hospital Revenue Code	270
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$150.25
Rate for Payer: Qualcare PPO/HMO/WC	$150.25

STOMATE FLXFLO MED 22F 50090

Facility

$1,001.65

Hospital Charge Code	270600965
Hospital Revenue Code	270
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$150.25
Rate for Payer: Qualcare PPO/HMO/WC	$150.25

STOMATE FLXFLO MED 22F 50090

Facility

$1,001.65

Hospital Charge Code	270600965
Hospital Revenue Code	270
Min. Negotiated Rate	$130.21
Max. Negotiated Rate	$500.82
Rate for Payer: Aetna Commercial	$300.50
Rate for Payer: Aetna Medicare Advantage	$300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.42
Rate for Payer: Cigna Commercial	$500.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.21
Rate for Payer: Oxford Commercial	$500.82
Rate for Payer: Qualcare PPO/HMO/WC	$150.25
Rate for Payer: UnitedHealthcare Commercial	$500.82

STOMATE FLXFLO SML 22F 50080

Facility

$1,001.65

Hospital Charge Code	270611260
Hospital Revenue Code	270
Min. Negotiated Rate	$130.21
Max. Negotiated Rate	$500.82
Rate for Payer: Aetna Commercial	$300.50
Rate for Payer: Aetna Medicare Advantage	$300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.42
Rate for Payer: Cigna Commercial	$500.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.21
Rate for Payer: Oxford Commercial	$500.82
Rate for Payer: Qualcare PPO/HMO/WC	$150.25
Rate for Payer: UnitedHealthcare Commercial	$500.82

STOMATE FLXFLO SML 22F 50080

Facility

$1,001.65

Hospital Charge Code	270611260
Hospital Revenue Code	270
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$150.25
Rate for Payer: Qualcare PPO/HMO/WC	$150.25

STONE ANALYSIS

Facility

$390.00

Service Code	HCPCS 82365
Hospital Charge Code	39900514
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STONE ANALYSIS

Facility

$658.00

Service Code	HCPCS 82365
Hospital Charge Code	38474158
Hospital Revenue Code	301
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$98.70
Rate for Payer: Qualcare PPO/HMO/WC	$98.70

STONE ANALYSIS

Facility

$658.00

Service Code	HCPCS 82365
Hospital Charge Code	38474158
Hospital Revenue Code	301
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.27
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: Cigna Medicare Advantage	$6.45
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.67
Rate for Payer: Wellcare Medicare Advantage	$12.90

STONE ANALYSIS

Facility

$390.00

Service Code	HCPCS 82365
Hospital Charge Code	39900514
Hospital Revenue Code	301
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.27
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: Cigna Medicare Advantage	$6.45
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.67
Rate for Payer: Wellcare Medicare Advantage	$12.90

STONE ANALYSIS INFRARED SPECT

Facility

$153.65

Service Code	HCPCS 82365
Hospital Charge Code	3004397
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

Know your out-of-pocket cost for care.

All Charges