Heights University Hospital

All Charges

Charge

Type

Setting

Price

DOWEL CANNUL REVISION 16X35MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270693721
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL FACET BACFAST HD 5MM

Facility

$16,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695407
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$4,875.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

DOWEL FACET BACFAST HD 5MM

Facility

$16,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695407
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

DOWEL REVISION 10 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688466
Hospital Revenue Code	272
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$1,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Commercial	$1,225.00

DOWEL REVISION 10 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688466
Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

DOWEL REVISION 11 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688465
Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

DOWEL REVISION 11 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688465
Hospital Revenue Code	272
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$1,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Commercial	$1,225.00

DOWEL REVISION 12 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688464
Hospital Revenue Code	272
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$1,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Commercial	$1,225.00

DOWEL REVISION 12 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688464
Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

DOWEL REVISION 13 MM KIT

Facility

$2,500.00

Hospital Charge Code	270688463
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

DOWEL REVISION 13 MM KIT

Facility

$2,500.00

Hospital Charge Code	270688463
Hospital Revenue Code	272
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$1,250.00

DOWEL REVISION 14 MM KIT

Facility

$2,500.00

Hospital Charge Code	270688468
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

DOWEL REVISION 14 MM KIT

Facility

$2,500.00

Hospital Charge Code	270688468
Hospital Revenue Code	272
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$1,250.00

DOWEL REVISION 9 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688467
Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

DOWEL REVISION 9 MM KIT

Facility

$2,450.00

Hospital Charge Code	270688467
Hospital Revenue Code	272
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$1,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Commercial	$1,225.00

DOXAPRAM HCL INJ 20MG/ML

Facility

$367.40

Hospital Charge Code	6002059
Hospital Revenue Code	250
Min. Negotiated Rate	$47.76
Max. Negotiated Rate	$183.70
Rate for Payer: Aetna Commercial	$110.22
Rate for Payer: Aetna Medicare Advantage	$110.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.69
Rate for Payer: Cigna Commercial	$183.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.76
Rate for Payer: Oxford Commercial	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$55.11
Rate for Payer: UnitedHealthcare Commercial	$183.70

DOXAPRAM HCL INJ 20MG/ML

Facility

$367.40

Hospital Charge Code	6002059
Hospital Revenue Code	250
Min. Negotiated Rate	$55.11
Max. Negotiated Rate	$55.11
Rate for Payer: Qualcare PPO/HMO/WC	$55.11

DOXAZOSIN 1 MG TAB

Facility

$25.19

Service Code	NDC 51079095720
Hospital Charge Code	60627628
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$7.56
Rate for Payer: Aetna Medicare Advantage	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$12.60

DOXAZOSIN 1 MG TAB

Facility

$25.19

Service Code	NDC 51079095720
Hospital Charge Code	60627628
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

DOXAZOSIN 2 MG TAB

Facility

$25.19

Service Code	NDC 51079095820
Hospital Charge Code	60627629
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

DOXAZOSIN 2 MG TAB

Facility

$25.19

Service Code	NDC 51079095820
Hospital Charge Code	60627629
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$7.56
Rate for Payer: Aetna Medicare Advantage	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$12.60

DOXAZOSIN 4MG TABLET

Facility

$21.31

Service Code	NDC 49277066
Hospital Charge Code	60632364
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.20

DOXAZOSIN 4MG TABLET

Facility

$21.31

Service Code	NDC 49277066
Hospital Charge Code	60632364
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$10.65
Rate for Payer: Aetna Commercial	$6.39
Rate for Payer: Aetna Medicare Advantage	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.43
Rate for Payer: Cigna Commercial	$10.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.77
Rate for Payer: Oxford Commercial	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.20
Rate for Payer: UnitedHealthcare Commercial	$10.65

DOXEPIN 100MG CAP

Facility

$13.20

Service Code	NDC 378641010
Hospital Charge Code	6063943101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.72
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$6.60

DOXEPIN 100MG CAP

Facility

$13.20

Service Code	NDC 378641010
Hospital Charge Code	6063943101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

Know your out-of-pocket cost for care.

All Charges