Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632992
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632992
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632993
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

FLAGYL PREMIX IV/500MG

Facility

$51.00

Hospital Charge Code	60634494
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$25.50

FLAGYL PREMIX IV/500MG

Facility

$51.00

Hospital Charge Code	60634494
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

FLANGE BREAST 2 BREAST CUST

Facility

$28.33

Hospital Charge Code	270665662
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

FLANGE BREAST 2 BREAST CUST

Facility

$28.33

Hospital Charge Code	270665662
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna Medicare Advantage	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.22
Rate for Payer: Cigna Commercial	$14.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

FLAREHAWK 11MM SHIM, 29MM

Facility

$10,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FLAREHAWK 11MM SHIM, 29MM

Facility

$10,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FLAREHAWK 7 SHORT SHELL

Facility

$18,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270692138
Hospital Revenue Code	278
Min. Negotiated Rate	$2,767.50
Max. Negotiated Rate	$9,225.00
Rate for Payer: Aetna Commercial	$5,535.00
Rate for Payer: Aetna Medicare Advantage	$5,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,704.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,704.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,704.75
Rate for Payer: Cigna Commercial	$9,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,464.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,767.50

FLAREHAWK 7 SHORT SHELL

Facility

$18,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270692138
Hospital Revenue Code	278
Min. Negotiated Rate	$2,767.50
Max. Negotiated Rate	$4,464.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,464.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,767.50

FLAREHAWK 7 SHORT SHIM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692139
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

FLAREHAWK 7 SHORT SHIM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692139
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$5,692.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

FLAREHWK SHELL TALL 25MM TIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697086
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$5,692.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

FLAREHWK SHELL TALL 25MM TIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697086
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

FLAREHWK SHIM 11/13X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$5,925.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

FLAREHWK SHIM 11/13X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

FLAREHWK SHIM 11/14X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

FLAREHWK SHIM 11/14X23/25MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$5,925.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

FLAT WASHER

Facility

$400.00

Hospital Charge Code	270680499
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

FLAT WASHER

Facility

$400.00

Hospital Charge Code	270680499
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

FLAT WASHER 6.5..

Facility

$292.50

Hospital Charge Code	270684882
Hospital Revenue Code	278
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$87.75
Rate for Payer: Aetna Medicare Advantage	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.78
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

FLAT WASHER 6.5..

Facility

$292.50

Hospital Charge Code	270684882
Hospital Revenue Code	278
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$70.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.78
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

FLAT WIRE 2.4F PLATINUM CLASS

Facility

$602.40

Hospital Charge Code	270682481
Hospital Revenue Code	272
Min. Negotiated Rate	$90.36
Max. Negotiated Rate	$90.36
Rate for Payer: Qualcare PPO/HMO/WC	$90.36

FLAT WIRE 2.4F PLATINUM CLASS

Facility

$602.40

Hospital Charge Code	270682481
Hospital Revenue Code	272
Min. Negotiated Rate	$78.31
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$180.72
Rate for Payer: Aetna Medicare Advantage	$180.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.61
Rate for Payer: Cigna Commercial	$301.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.31
Rate for Payer: Oxford Commercial	$301.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.36
Rate for Payer: UnitedHealthcare Commercial	$301.20

Know your out-of-pocket cost for care.

All Charges