Heights University Hospital

All Charges

Charge

Type

Setting

Price

BOOTIE SUTURE-AID YEL 05-1-003

Facility

$24.85

Hospital Charge Code	270060185
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$7.46
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$12.43

BOOTIE SUTURE-AID YEL 05-1-003

Facility

$24.85

Hospital Charge Code	270060185
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

BOOTLEG DISPOSABLE FLUID PROTE

Facility

$42.10

Hospital Charge Code	270657352
Hospital Revenue Code	270
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

BOOTLEG DISPOSABLE FLUID PROTE

Facility

$42.10

Hospital Charge Code	270657352
Hospital Revenue Code	270
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$12.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.74
Rate for Payer: Cigna Commercial	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.47
Rate for Payer: Oxford Commercial	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$21.05

BOOT LEG FLUID PROTECTION

Facility

$106.00

Hospital Charge Code	270335514
Hospital Revenue Code	272
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$53.00

BOOT LEG FLUID PROTECTION

Facility

$106.00

Hospital Charge Code	270335514
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

BOOT MULTIPODOUS LG 303404306D

Facility

$242.50

Hospital Charge Code	270302905
Hospital Revenue Code	272
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$72.75
Rate for Payer: Aetna Medicare Advantage	$72.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.84
Rate for Payer: Cigna Commercial	$121.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.52
Rate for Payer: Oxford Commercial	$121.25
Rate for Payer: Qualcare PPO/HMO/WC	$36.38
Rate for Payer: UnitedHealthcare Commercial	$121.25

BOOT MULTIPODOUS LG 303404306D

Facility

$242.50

Hospital Charge Code	270302905
Hospital Revenue Code	272
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$36.38
Rate for Payer: Qualcare PPO/HMO/WC	$36.38

BOOT MULTIPODUS SMALL 430B

Facility

$320.00

Service Code	HCPCS L4396
Hospital Charge Code	270612640
Hospital Revenue Code	274
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$201.26
Rate for Payer: Aetna Commercial	$96.00
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$201.26
Rate for Payer: Cigna Medicare Advantage	$120.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

BOOT MULTIPODUS SMALL 430B

Facility

$320.00

Service Code	HCPCS L4396
Hospital Charge Code	270612640
Hospital Revenue Code	274
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

BOOT MULTIPOROUS AMB CUSTOM

Facility

$1,536.00

Hospital Charge Code	270613128
Hospital Revenue Code	274
Min. Negotiated Rate	$230.40
Max. Negotiated Rate	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.71
Rate for Payer: Qualcare PPO/HMO/WC	$230.40

BOOT MULTIPOROUS AMB CUSTOM

Facility

$1,536.00

Hospital Charge Code	270613128
Hospital Revenue Code	274
Min. Negotiated Rate	$230.40
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$460.80
Rate for Payer: Aetna Medicare Advantage	$460.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.68
Rate for Payer: Cigna Commercial	$768.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.71
Rate for Payer: Qualcare PPO/HMO/WC	$230.40

BOOT N/C FULL COVER LARGE

Facility

$113.33

Hospital Charge Code	270650459
Hospital Revenue Code	272
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

BOOT N/C FULL COVER LARGE

Facility

$113.33

Hospital Charge Code	270650459
Hospital Revenue Code	272
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$56.66
Rate for Payer: Aetna Commercial	$34.00
Rate for Payer: Aetna Medicare Advantage	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.90
Rate for Payer: Cigna Commercial	$56.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$56.66
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$56.66

BOOT REGULAR TCC-EX

Facility

$351.75

Hospital Charge Code	270639683
Hospital Revenue Code	270
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$52.76
Rate for Payer: Qualcare PPO/HMO/WC	$52.76

BOOT REGULAR TCC-EX

Facility

$351.75

Hospital Charge Code	270639683
Hospital Revenue Code	270
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$175.88
Rate for Payer: Aetna Commercial	$105.53
Rate for Payer: Aetna Medicare Advantage	$105.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.70
Rate for Payer: Cigna Commercial	$175.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.73
Rate for Payer: Oxford Commercial	$175.88
Rate for Payer: Qualcare PPO/HMO/WC	$52.76
Rate for Payer: UnitedHealthcare Commercial	$175.88

BOOT ROCKER LEFT CUST.

Facility

$1,659.25

Hospital Charge Code	270612781
Hospital Revenue Code	270
Min. Negotiated Rate	$248.89
Max. Negotiated Rate	$248.89
Rate for Payer: Qualcare PPO/HMO/WC	$248.89

BOOT ROCKER LEFT CUST.

Facility

$1,659.25

Hospital Charge Code	270612781
Hospital Revenue Code	270
Min. Negotiated Rate	$215.70
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna Commercial	$497.77
Rate for Payer: Aetna Medicare Advantage	$497.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.11
Rate for Payer: Cigna Commercial	$829.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$829.62
Rate for Payer: Qualcare PPO/HMO/WC	$248.89
Rate for Payer: UnitedHealthcare Commercial	$829.62

BOOT UNNA W/ZINC 3 GL30001

Facility

$28.08

Hospital Charge Code	270639056
Hospital Revenue Code	270
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.21

BOOT UNNA W/ZINC 3 GL30001

Facility

$28.08

Hospital Charge Code	270639056
Hospital Revenue Code	270
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$14.04
Rate for Payer: Aetna Commercial	$8.42
Rate for Payer: Aetna Medicare Advantage	$8.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.16
Rate for Payer: Cigna Commercial	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.65
Rate for Payer: Oxford Commercial	$14.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.21
Rate for Payer: UnitedHealthcare Commercial	$14.04

BOOT UNNA W/ZINC 4 GL4001

Facility

$32.69

Hospital Charge Code	270639053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$16.34
Rate for Payer: Aetna Commercial	$9.81
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.34
Rate for Payer: Cigna Commercial	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.25
Rate for Payer: Oxford Commercial	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$4.90
Rate for Payer: UnitedHealthcare Commercial	$16.34

BOOT UNNA W/ZINC 4 GL4001

Facility

$32.69

Hospital Charge Code	270639053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

BORDETELLA PERTUSIS CULT

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475102
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.93
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
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	$31.58
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.14
Rate for Payer: Wellcare Medicare Advantage	$8.62

BORDETELLA PERTUSIS CULT

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475102
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

BORDETELLA PERTUSSIS ANTIBODY

Facility

$309.65

Service Code	HCPCS 87265
Hospital Charge Code	3009784
Hospital Revenue Code	309
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$46.45
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

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