Heights University Hospital

All Charges

Charge

Type

Setting

Price

DYE OMNIPAQUE 350 50ML Y410

Facility

$65.65

Hospital Charge Code	270601304
Hospital Revenue Code	272
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$19.70
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.53
Rate for Payer: Oxford Commercial	$32.83
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$32.83

DYE OMNIPAQUE 350 50ML Y410

Facility

$65.65

Hospital Charge Code	270601304
Hospital Revenue Code	272
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

DYE SPIKE (CUSTOM)

Facility

$11.50

Hospital Charge Code	2709001617
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$5.75
Rate for Payer: Aetna Commercial	$3.45
Rate for Payer: Aetna Medicare Advantage	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.93
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.73
Rate for Payer: UnitedHealthcare Commercial	$5.75

DYE SPIKE (CUSTOM)

Facility

$2.30

Hospital Charge Code	270623864N
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.35

DYE SPIKE (CUSTOM)

Facility

$10.30

Hospital Charge Code	270623864S
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

DYE SPIKE (CUSTOM)

Facility

$10.30

Hospital Charge Code	270623864S
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$5.15
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna Medicare Advantage	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.63
Rate for Payer: Cigna Commercial	$5.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$5.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.15

DYE SPIKE (CUSTOM)

Facility

$11.50

Hospital Charge Code	2709001617
Hospital Revenue Code	272
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.73

DYE SPIKE (CUSTOM)

Facility

$2.30

Hospital Charge Code	270623864N
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna Commercial	$0.69
Rate for Payer: Aetna Medicare Advantage	$0.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.59
Rate for Payer: Cigna Commercial	$1.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.35
Rate for Payer: UnitedHealthcare Commercial	$1.15

DYE SPIKE (CUSTOM)

Facility

$10.30

Hospital Charge Code	270623864
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$5.15
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna Medicare Advantage	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.63
Rate for Payer: Cigna Commercial	$5.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$5.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.15

DYE SPIKE (CUSTOM)

Facility

$10.30

Hospital Charge Code	270623864
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

DYMELOR/250MG/TAB

Facility

$3.00

Hospital Charge Code	60632917
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

DYMELOR/250MG/TAB

Facility

$3.00

Hospital Charge Code	60634368
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

DYMELOR/250MG/TAB

Facility

$3.00

Hospital Charge Code	60634368
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DYMELOR/250MG/TAB

Facility

$3.00

Hospital Charge Code	60632917
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DYMELOR/500MG/TAB

Facility

$6.00

Hospital Charge Code	60632918
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

DYMELOR/500MG/TAB

Facility

$6.00

Hospital Charge Code	60632918
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DYNAMIC EXTENSION SPLINT

Facility

$106.00

Hospital Charge Code	74203133
Hospital Revenue Code	270
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

DYNAMIC EXTENSION SPLINT

Facility

$106.00

Hospital Charge Code	74203133
Hospital Revenue Code	270
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

DYNAMITE PIP BENT W/INST 14MM

Facility

$10,266.75

Service Code	HCPCS C1713
Hospital Charge Code	270698523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.01
Max. Negotiated Rate	$5,133.38
Rate for Payer: Aetna Commercial	$3,080.03
Rate for Payer: Aetna Medicare Advantage	$3,080.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,618.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,618.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,618.02
Rate for Payer: Cigna Commercial	$5,133.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.01

DYNAMITE PIP BENT W/INST 14MM

Facility

$10,266.75

Service Code	HCPCS C1713
Hospital Charge Code	270698523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.01
Max. Negotiated Rate	$2,484.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.01

DYNANITE PIP IMPLANT 16MM

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

DYNANITE PIP IMPLANT 16MM

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$2,842.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

DYNANITE STAPLE 11X10L

Facility

$7,475.00

Hospital Charge Code	270686093
Hospital Revenue Code	272
Min. Negotiated Rate	$971.75
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.75
Rate for Payer: Oxford Commercial	$3,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$3,737.50

DYNANITE STAPLE 11X10L

Facility

$7,475.00

Hospital Charge Code	270686093
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

DYNANITE STAPLE9WX10L

Facility

$7,475.00

Hospital Charge Code	270686092
Hospital Revenue Code	272
Min. Negotiated Rate	$971.75
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.75
Rate for Payer: Oxford Commercial	$3,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$3,737.50

Know your out-of-pocket cost for care.

All Charges