Heights University Hospital

All Charges

Charge

Type

Setting

Price

G7 OSSEOTI MULTIHOLE 52MM E

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270689980
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

G7 OSSEOTI MULTIHOLE 54MM F

Facility

$800.00

Service Code	HCPCS C1776
Hospital Charge Code	270684665
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

G7 OSSEOTI MULTIHOLE 54MM F

Facility

$800.00

Service Code	HCPCS C1776
Hospital Charge Code	270684665
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

G7 SCREW 6.5MM X 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680634
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680634
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 40MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680635
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 40MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680635
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 45MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681044
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 45MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681044
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SUCTION CUP STERILE

Facility

$390.00

Hospital Charge Code	270686370
Hospital Revenue Code	272
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$195.00

G7 SUCTION CUP STERILE

Facility

$390.00

Hospital Charge Code	270686370
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

G7 VIT E FRDM CONST LNR 36MM F

Facility

$24,995.00

Hospital Charge Code	270702525
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

G7 VIT E FRDM CONST LNR 36MM F

Facility

$24,995.00

Hospital Charge Code	270702525
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$7,498.50
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

G7 VIT E HIGH WALL LNR 36MM F

Facility

$12,000.00

Hospital Charge Code	270702411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

G7 VIT E HIGH WALL LNR 36MM F

Facility

$12,000.00

Hospital Charge Code	270702411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

GA67 CITRATE 6.0 MCI

Facility

$204.87

Service Code	HCPCS A9566
Hospital Charge Code	4509073
Hospital Revenue Code	343
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$102.44
Rate for Payer: Aetna Commercial	$61.46
Rate for Payer: Aetna Medicare Advantage	$61.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.24
Rate for Payer: Cigna Commercial	$102.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.63
Rate for Payer: Qualcare PPO/HMO/WC	$30.73

GA67 CITRATE 6.0 MCI

Facility

$204.87

Service Code	HCPCS A9566
Hospital Charge Code	4509073
Hospital Revenue Code	343
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$30.73

GABAPENTIN

Facility

$390.00

Service Code	HCPCS 80171
Hospital Charge Code	39900503
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GABAPENTIN

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3032380
Hospital Revenue Code	301
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

GABAPENTIN

Facility

$390.00

Service Code	HCPCS 80171
Hospital Charge Code	39900503
Hospital Revenue Code	301
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.21
Rate for Payer: Aetna Medicare Advantage	$21.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.40
Rate for Payer: Cigna Commercial	$21.67
Rate for Payer: Cigna Medicare Advantage	$10.84
Rate for Payer: Clover Medicare Advantage	$20.59
Rate for Payer: EmblemHealth Commercial	$65.01
Rate for Payer: Humana Medicare Advantage	$22.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.97
Rate for Payer: Wellcare Medicare Advantage	$21.67

GABAPENTIN

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3032380
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

GABAPENTIN 100 MG CAP

Facility

$5.96

Service Code	NDC 63739067510
Hospital Charge Code	60627750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

GABAPENTIN 100 MG CAP

Facility

$5.96

Service Code	NDC 63739067510
Hospital Charge Code	60627750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$1.79
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$2.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.77
Rate for Payer: Oxford Commercial	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$2.98

GABAPENTIN 250MG/5ML SOL

Facility

$20.23

Service Code	NDC 71201247
Hospital Charge Code	60632259
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.03

GABAPENTIN 250MG/5ML SOL

Facility

$20.23

Service Code	NDC 71201247
Hospital Charge Code	60632259
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna Commercial	$6.07
Rate for Payer: Aetna Medicare Advantage	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.16
Rate for Payer: Cigna Commercial	$10.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.63
Rate for Payer: Oxford Commercial	$10.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.03
Rate for Payer: UnitedHealthcare Commercial	$10.12

Know your out-of-pocket cost for care.

All Charges