Heights University Hospital

All Charges

Charge

Type

Setting

Price

SURGICAL MATRIX 8X16CM

Facility

$18,144.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,390.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,390.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,721.60

SURGICAL MATRIX 8X16CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662094W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$34.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26

SURGICAL MATRIX 8X16CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662094W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare Advantage	$42.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.15
Rate for Payer: Cigna Commercial	$70.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26

SURGICAL PATHOLOGY/BIOPSY***

Facility

$68.00

Hospital Charge Code	3600020
Hospital Revenue Code	309
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna Medicare Advantage	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.34
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

SURGICAL PATHOLOGY/BIOPSY***

Facility

$68.00

Hospital Charge Code	3600020
Hospital Revenue Code	309
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

SURGICAL PATTI 1/2 X 1

Facility

$44.00

Hospital Charge Code	270332279
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SURGICAL PATTI 1/2 X 1

Facility

$44.00

Hospital Charge Code	270332279
Hospital Revenue Code	272
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

SURGICAL PATTIES 1X1

Facility

$44.00

Hospital Charge Code	270332417
Hospital Revenue Code	272
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

SURGICAL PATTIES 1X1

Facility

$44.00

Hospital Charge Code	270332417
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SURGICEL 1/2 X 2 *******

Facility

$30.00

Hospital Charge Code	1601178
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

SURGICEL 1/2 X 2 *******

Facility

$30.00

Hospital Charge Code	1601178
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SURGICEL 2 X 14 *******

Facility

$88.00

Hospital Charge Code	1601186
Hospital Revenue Code	272
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$26.40
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$44.00

SURGICEL 2 X 14 *******

Facility

$88.00

Hospital Charge Code	1601186
Hospital Revenue Code	272
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

SURGICEL 2X3

Facility

$150.45

Hospital Charge Code	270060852
Hospital Revenue Code	272
Min. Negotiated Rate	$19.56
Max. Negotiated Rate	$75.22
Rate for Payer: Aetna Commercial	$45.13
Rate for Payer: Aetna Medicare Advantage	$45.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.36
Rate for Payer: Cigna Commercial	$75.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.56
Rate for Payer: Oxford Commercial	$75.22
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$75.22

SURGICEL 2X3

Facility

$245.80

Hospital Charge Code	6006936
Hospital Revenue Code	250
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$122.90
Rate for Payer: Aetna Commercial	$73.74
Rate for Payer: Aetna Medicare Advantage	$73.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.68
Rate for Payer: Cigna Commercial	$122.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.95
Rate for Payer: Oxford Commercial	$122.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.87
Rate for Payer: UnitedHealthcare Commercial	$122.90

SURGICEL 2X3

Facility

$150.45

Hospital Charge Code	270060852
Hospital Revenue Code	272
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

SURGICEL 2X3

Facility

$245.80

Hospital Charge Code	6006936
Hospital Revenue Code	250
Min. Negotiated Rate	$36.87
Max. Negotiated Rate	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$36.87

SURGICEL 2x3 3460001953

Facility

$161.25

Hospital Charge Code	270641422
Hospital Revenue Code	272
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$80.62
Rate for Payer: Aetna Commercial	$48.38
Rate for Payer: Aetna Medicare Advantage	$48.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.12
Rate for Payer: Cigna Commercial	$80.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.96
Rate for Payer: Oxford Commercial	$80.62
Rate for Payer: Qualcare PPO/HMO/WC	$24.19
Rate for Payer: UnitedHealthcare Commercial	$80.62

SURGICEL 2x3 3460001953

Facility

$161.25

Hospital Charge Code	270641422
Hospital Revenue Code	272
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$24.19
Rate for Payer: Qualcare PPO/HMO/WC	$24.19

SURGICEL 2X4

Facility

$228.00

Hospital Charge Code	270060850
Hospital Revenue Code	272
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$68.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.14
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.64
Rate for Payer: Oxford Commercial	$114.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

SURGICEL 2X4

Facility

$228.00

Hospital Charge Code	270060850
Hospital Revenue Code	272
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Qualcare PPO/HMO/WC	$34.20

SURGICEL 4 X 8 ********

Facility

$98.00

Hospital Charge Code	1600915
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

SURGICEL 4 X 8 ********

Facility

$98.00

Hospital Charge Code	1600915
Hospital Revenue Code	272
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$29.40
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.74
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$49.00

SURGICEL 4X8

Facility

$597.57

Hospital Charge Code	270650484
Hospital Revenue Code	272
Min. Negotiated Rate	$89.64
Max. Negotiated Rate	$89.64
Rate for Payer: Qualcare PPO/HMO/WC	$89.64

SURGICEL 4X8

Facility

$597.57

Hospital Charge Code	270650484
Hospital Revenue Code	272
Min. Negotiated Rate	$77.68
Max. Negotiated Rate	$298.79
Rate for Payer: Aetna Commercial	$179.27
Rate for Payer: Aetna Medicare Advantage	$179.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.38
Rate for Payer: Cigna Commercial	$298.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.68
Rate for Payer: Oxford Commercial	$298.79
Rate for Payer: Qualcare PPO/HMO/WC	$89.64
Rate for Payer: UnitedHealthcare Commercial	$298.79

Know your out-of-pocket cost for care.

All Charges