Heights University Hospital

All Charges

Charge

Type

Setting

Price

BOTTLE SPRY FM 28ML 4509003346

Facility

$37.50

Hospital Charge Code	270641452W
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Aetna Medicare Advantage	$11.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.56
Rate for Payer: Cigna Commercial	$18.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$18.75

BOTTLE SPRY FM 28ML 4509003346

Facility

$37.50

Hospital Charge Code	270641452W
Hospital Revenue Code	272
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

BOTTLE STERILE SALINE POUR

Facility

$18.45

Hospital Charge Code	270612190
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

BOTTLE STERILE SALINE POUR

Facility

$18.45

Hospital Charge Code	270612190
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$9.22

BOTTLE THOROSEAL REPLAC 713900

Facility

$144.85

Hospital Charge Code	270300906
Hospital Revenue Code	272
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$72.42
Rate for Payer: Aetna Commercial	$43.45
Rate for Payer: Aetna Medicare Advantage	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.94
Rate for Payer: Cigna Commercial	$72.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.83
Rate for Payer: Oxford Commercial	$72.42
Rate for Payer: Qualcare PPO/HMO/WC	$21.73
Rate for Payer: UnitedHealthcare Commercial	$72.42

BOTTLE THOROSEAL REPLAC 713900

Facility

$144.85

Hospital Charge Code	270300906
Hospital Revenue Code	272
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$21.73
Rate for Payer: Qualcare PPO/HMO/WC	$21.73

BOTTLE VACUUM 1000 ********

Facility

$69.00

Hospital Charge Code	7000649
Hospital Revenue Code	279
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Oxford Commercial	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$34.50

BOTTLE VACUUM 1000 ********

Facility

$69.00

Hospital Charge Code	7000649
Hospital Revenue Code	279
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

BOTTLE VACUUM 1000ML

Facility

$13.65

Hospital Charge Code	270303225
Hospital Revenue Code	270
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

BOTTLE VACUUM 1000ML

Facility

$13.65

Hospital Charge Code	270303225
Hospital Revenue Code	270
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

BOTTLE VACUUM 500 *******

Facility

$36.00

Hospital Charge Code	7000631
Hospital Revenue Code	279
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

BOTTLE VACUUM 500 *******

Facility

$36.00

Hospital Charge Code	7000631
Hospital Revenue Code	279
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.68
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$18.00

BOTULINUM TOXIN TYPE A 100U

Facility

$4,832.04

Service Code	HCPCS J0585
Hospital Charge Code	606390191
Hospital Revenue Code	636
Min. Negotiated Rate	$724.81
Max. Negotiated Rate	$1,169.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,169.35
Rate for Payer: Qualcare PPO/HMO/WC	$724.81

BOTULINUM TOXIN TYPE A 100U

Facility

$4,832.04

Service Code	HCPCS J0585
Hospital Charge Code	606390191
Hospital Revenue Code	636
Min. Negotiated Rate	$724.81
Max. Negotiated Rate	$1,449.61
Rate for Payer: Aetna Commercial	$1,449.61
Rate for Payer: Aetna Medicare Advantage	$1,449.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,232.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,232.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,232.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,169.35
Rate for Payer: Qualcare PPO/HMO/WC	$724.81

BOTULINUM TOXIN TYPE A INJ/1M

Facility

$3,150.00

Hospital Charge Code	60628765
Hospital Revenue Code	636
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

BOTULINUM TOXIN TYPE A INJ/1M

Facility

$3,150.00

Hospital Charge Code	60628765
Hospital Revenue Code	636
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

BOUGIE M-FLEX BLUE 52FR

Facility

$1,445.00

Hospital Charge Code	270683619
Hospital Revenue Code	272
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$216.75
Rate for Payer: Qualcare PPO/HMO/WC	$216.75

BOUGIE M-FLEX BLUE 52FR

Facility

$1,445.00

Hospital Charge Code	270683619
Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$722.50
Rate for Payer: Aetna Commercial	$433.50
Rate for Payer: Aetna Medicare Advantage	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.48
Rate for Payer: Cigna Commercial	$722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.85
Rate for Payer: Oxford Commercial	$722.50
Rate for Payer: Qualcare PPO/HMO/WC	$216.75
Rate for Payer: UnitedHealthcare Commercial	$722.50

BOUGIE M-FLEX BLUE 54FR

Facility

$1,445.00

Hospital Charge Code	270683621
Hospital Revenue Code	272
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$216.75
Rate for Payer: Qualcare PPO/HMO/WC	$216.75

BOUGIE M-FLEX BLUE 54FR

Facility

$1,445.00

Hospital Charge Code	270683621
Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$722.50
Rate for Payer: Aetna Commercial	$433.50
Rate for Payer: Aetna Medicare Advantage	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.48
Rate for Payer: Cigna Commercial	$722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.85
Rate for Payer: Oxford Commercial	$722.50
Rate for Payer: Qualcare PPO/HMO/WC	$216.75
Rate for Payer: UnitedHealthcare Commercial	$722.50

BOUGIE M-FLEX BLUE 54FR

Facility

$1,445.00

Hospital Charge Code	270683620
Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$722.50
Rate for Payer: Aetna Commercial	$433.50
Rate for Payer: Aetna Medicare Advantage	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.48
Rate for Payer: Cigna Commercial	$722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.85
Rate for Payer: Oxford Commercial	$722.50
Rate for Payer: Qualcare PPO/HMO/WC	$216.75
Rate for Payer: UnitedHealthcare Commercial	$722.50

BOUGIE M-FLEX BLUE 54FR

Facility

$1,445.00

Hospital Charge Code	270683620
Hospital Revenue Code	272
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$216.75
Rate for Payer: Qualcare PPO/HMO/WC	$216.75

BOURDEAUXS BUTT PASTE

Facility

$15.08

Service Code	NDC 62103033300
Hospital Charge Code	606380038
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$2.26
Rate for Payer: Qualcare PPO/HMO/WC	$2.26

BOURDEAUXS BUTT PASTE

Facility

$15.08

Service Code	NDC 62103033300
Hospital Charge Code	606380038
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$7.54
Rate for Payer: Aetna Commercial	$4.52
Rate for Payer: Aetna Medicare Advantage	$4.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.96
Rate for Payer: Oxford Commercial	$7.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.26
Rate for Payer: UnitedHealthcare Commercial	$7.54

BOWER PEG KIT 20FR

Facility

$744.00

Hospital Charge Code	270332542
Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

Know your out-of-pocket cost for care.

All Charges