Heights University Hospital

All Charges

Charge

Type

Setting

Price

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

COUMADIN 4MG

Facility

$14.94

Service Code	NDC 56016870
Hospital Charge Code	60635727
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.24

COUMADIN 4MG

Facility

$14.94

Service Code	NDC 56016870
Hospital Charge Code	60635727
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$7.47
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare Advantage	$4.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.81
Rate for Payer: Cigna Commercial	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: Oxford Commercial	$7.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.24
Rate for Payer: UnitedHealthcare Commercial	$7.47

COUMADIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COUMADIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

COUNSELING/RISK FACTOR 15 MINS

Facility

$134.00

Service Code	HCPCS 99401
Hospital Charge Code	9200095
Hospital Revenue Code	761
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$40.20
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.42
Rate for Payer: Oxford Commercial	$67.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$67.00

COUNSELING/RISK FACTOR 15 MINS

Facility

$134.00

Service Code	HCPCS 99401
Hospital Charge Code	9200095
Hospital Revenue Code	761
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

COUNTERSINK

Facility

$1,545.00

Hospital Charge Code	270688016
Hospital Revenue Code	272
Min. Negotiated Rate	$200.85
Max. Negotiated Rate	$772.50
Rate for Payer: Aetna Commercial	$463.50
Rate for Payer: Aetna Medicare Advantage	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.98
Rate for Payer: Cigna Commercial	$772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.85
Rate for Payer: Oxford Commercial	$772.50
Rate for Payer: Qualcare PPO/HMO/WC	$231.75
Rate for Payer: UnitedHealthcare Commercial	$772.50

COUNTERSINK

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270669670
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

COUNTERSINK

Facility

$624.20

Hospital Charge Code	270665618
Hospital Revenue Code	278
Min. Negotiated Rate	$93.63
Max. Negotiated Rate	$312.10
Rate for Payer: Aetna Commercial	$187.26
Rate for Payer: Aetna Medicare Advantage	$187.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.17
Rate for Payer: Cigna Commercial	$312.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: Qualcare PPO/HMO/WC	$93.63

COUNTERSINK

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270669670
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

COUNTERSINK

Facility

$624.20

Hospital Charge Code	270665618
Hospital Revenue Code	278
Min. Negotiated Rate	$93.63
Max. Negotiated Rate	$151.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: Qualcare PPO/HMO/WC	$93.63

COUNTERSINK

Facility

$1,545.00

Hospital Charge Code	270688016
Hospital Revenue Code	272
Min. Negotiated Rate	$231.75
Max. Negotiated Rate	$231.75
Rate for Payer: Qualcare PPO/HMO/WC	$231.75

COUNTERSINK 2.5

Facility

$680.00

Hospital Charge Code	270692677
Hospital Revenue Code	272
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$204.00
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.40
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$340.00

COUNTERSINK 2.5

Facility

$680.00

Hospital Charge Code	270692677
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

COUNTERSINK 2.7/3.5MM

Facility

$940.00

Service Code	HCPCS C1713
Hospital Charge Code	270667254
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$470.00
Rate for Payer: Aetna Commercial	$282.00
Rate for Payer: Aetna Medicare Advantage	$282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.70
Rate for Payer: Cigna Commercial	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.48
Rate for Payer: Qualcare PPO/HMO/WC	$141.00

COUNTERSINK 2.7/3.5MM

Facility

$940.00

Service Code	HCPCS C1713
Hospital Charge Code	270667254
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$227.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.48
Rate for Payer: Qualcare PPO/HMO/WC	$141.00

COUNTERSINK 4.00 HEADLESS

Facility

$1,550.00

Hospital Charge Code	270690337
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

COUNTERSINK 4.00 HEADLESS

Facility

$1,550.00

Hospital Charge Code	270690337
Hospital Revenue Code	272
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$465.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.50
Rate for Payer: Oxford Commercial	$775.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Commercial	$775.00

COUNTERSINK 4 5MM

Facility

$1,000.00

Hospital Charge Code	270680218
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$500.00

COUNTERSINK 4 5MM

Facility

$1,000.00

Hospital Charge Code	270680218
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

COUNTERSINK 4MM CANN HD DRVR

Facility

$660.00

Hospital Charge Code	270700812
Hospital Revenue Code	272
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$198.00
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Commercial	$330.00

COUNTERSINK 4MM CANN HD DRVR

Facility

$660.00

Hospital Charge Code	270700812
Hospital Revenue Code	272
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

Know your out-of-pocket cost for care.

All Charges