Heights University Hospital

All Charges

Charge

Type

Setting

Price

FORTAZ/6GM

Facility

$490.00

Hospital Charge Code	60633015
Hospital Revenue Code	250
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$147.00
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$245.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Commercial	$245.00

FORTE CNCLLOUS SCRE 4.0MMX12MM

Facility

$299.10

Hospital Charge Code	270663184
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRE 4.0MMX12MM

Facility

$299.10

Hospital Charge Code	270663184
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX10MM

Facility

$299.10

Hospital Charge Code	270663183
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX10MM

Facility

$299.10

Hospital Charge Code	270663183
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX18MM

Facility

$299.10

Hospital Charge Code	270663185
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX18MM

Facility

$299.10

Hospital Charge Code	270663185
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX22MM

Facility

$299.10

Hospital Charge Code	270663186
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX22MM

Facility

$299.10

Hospital Charge Code	270663186
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX24MM

Facility

$299.10

Hospital Charge Code	270663187
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX24MM

Facility

$299.10

Hospital Charge Code	270663187
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX26MM

Facility

$299.10

Hospital Charge Code	270663188
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX26MM

Facility

$299.10

Hospital Charge Code	270663188
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX28MM

Facility

$299.10

Hospital Charge Code	270663189
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$149.55
Rate for Payer: Aetna Commercial	$89.73
Rate for Payer: Aetna Medicare Advantage	$89.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.27
Rate for Payer: Cigna Commercial	$149.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTE CNCLLOUS SCRW 4.0MMX28MM

Facility

$299.10

Hospital Charge Code	270663189
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$44.87

FORTEC XPS MOXY FIBER

Facility

$5,000.00

Hospital Charge Code	270657506
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

FORTEC XPS MOXY FIBER

Facility

$5,000.00

Hospital Charge Code	270657506
Hospital Revenue Code	272
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

FORTIFIED TOBREX OPHTH

Facility

$150.00

Hospital Charge Code	60634815
Hospital Revenue Code	250
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$75.00

FORTIFIED TOBREX OPHTH

Facility

$150.00

Hospital Charge Code	60634815
Hospital Revenue Code	250
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

FORTILINK 8CM

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270689963
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FORTILINK 8CM

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270689963
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FORTILINK-C CAGE 12X14X9MM 6D

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695702
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

FORTILINK-C CAGE 12X14X9MM 6D

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695702
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$6,450.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

FORTLINK 7CM

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270689962
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FORTLINK 7CM

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270689962
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges