Heights University Hospital

All Charges

Charge

Type

Setting

Price

RETACRIT ALFA-EPBX 2000IU/ML

Facility

$176.95

Service Code	NDC 69130510
Hospital Charge Code	606390489
Hospital Revenue Code	634
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$26.54
Rate for Payer: Qualcare PPO/HMO/WC	$26.54

RETACRIT ALFA-EPBX 2000IU/ML

Facility

$176.95

Service Code	NDC 69130510
Hospital Charge Code	606390489
Hospital Revenue Code	634
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$88.47
Rate for Payer: Aetna Commercial	$53.09
Rate for Payer: Aetna Medicare Advantage	$53.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.12
Rate for Payer: Cigna Commercial	$88.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.00
Rate for Payer: Oxford Commercial	$88.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.54
Rate for Payer: UnitedHealthcare Commercial	$88.47

RETACRIT ALFA-EPBX 3000IU/ML

Facility

$265.99

Service Code	NDC 69130610
Hospital Charge Code	606390490
Hospital Revenue Code	634
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

RETACRIT ALFA-EPBX 3000IU/ML

Facility

$265.99

Service Code	NDC 69130610
Hospital Charge Code	606390490
Hospital Revenue Code	634
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$133.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$133.00

RETACRIT SAL SOL 10,000U/ML

Facility

$884.40

Service Code	NDC 69130810
Hospital Charge Code	606390459
Hospital Revenue Code	635
Min. Negotiated Rate	$132.66
Max. Negotiated Rate	$132.66
Rate for Payer: Qualcare PPO/HMO/WC	$132.66

RETACRIT SAL SOL 10,000U/ML

Facility

$884.40

Service Code	NDC 69130810
Hospital Charge Code	606390459
Hospital Revenue Code	635
Min. Negotiated Rate	$114.97
Max. Negotiated Rate	$442.20
Rate for Payer: Aetna Commercial	$265.32
Rate for Payer: Aetna Medicare Advantage	$265.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.52
Rate for Payer: Cigna Commercial	$442.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$442.20
Rate for Payer: Qualcare PPO/HMO/WC	$132.66
Rate for Payer: UnitedHealthcare Commercial	$442.20

RETACRIT SAL SOL 4000U/ML

Facility

$348.40

Service Code	NDC 69130710
Hospital Charge Code	606390458
Hospital Revenue Code	634
Min. Negotiated Rate	$45.29
Max. Negotiated Rate	$174.20
Rate for Payer: Aetna Commercial	$104.52
Rate for Payer: Aetna Medicare Advantage	$104.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.84
Rate for Payer: Cigna Commercial	$174.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.29
Rate for Payer: Oxford Commercial	$174.20
Rate for Payer: Qualcare PPO/HMO/WC	$52.26
Rate for Payer: UnitedHealthcare Commercial	$174.20

RETACRIT SAL SOL 4000U/ML

Facility

$348.40

Service Code	NDC 69130710
Hospital Charge Code	606390458
Hospital Revenue Code	634
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$52.26

RETAINER NUT

Facility

$276.00

Hospital Charge Code	270692632
Hospital Revenue Code	272
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$82.80
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$138.00

RETAINER NUT

Facility

$276.00

Hospital Charge Code	270692632
Hospital Revenue Code	272
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

RETAINER VISCERA

Facility

$131.50

Hospital Charge Code	270600379
Hospital Revenue Code	272
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$65.75
Rate for Payer: Aetna Commercial	$39.45
Rate for Payer: Aetna Medicare Advantage	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.53
Rate for Payer: Cigna Commercial	$65.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.09
Rate for Payer: Oxford Commercial	$65.75
Rate for Payer: Qualcare PPO/HMO/WC	$19.73
Rate for Payer: UnitedHealthcare Commercial	$65.75

RETAINER VISCERA

Facility

$131.50

Hospital Charge Code	270600379
Hospital Revenue Code	272
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$19.73
Rate for Payer: Qualcare PPO/HMO/WC	$19.73

RETAINER VISCERA MEDIUM*******

Facility

$73.00

Hospital Charge Code	1605831
Hospital Revenue Code	279
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

RETAINER VISCERA MEDIUM*******

Facility

$73.00

Hospital Charge Code	1605831
Hospital Revenue Code	279
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

RETAINING FEMORAL CRUCIATE

Facility

$8,512.20

Service Code	HCPCS C1713
Hospital Charge Code	270704016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.83
Max. Negotiated Rate	$2,059.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,702.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,059.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,276.83

RETAINING FEMORAL CRUCIATE

Facility

$8,512.20

Service Code	HCPCS C1713
Hospital Charge Code	270704016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.83
Max. Negotiated Rate	$4,256.10
Rate for Payer: Aetna Commercial	$2,553.66
Rate for Payer: Aetna Medicare Advantage	$2,553.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,170.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,170.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,702.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,170.61
Rate for Payer: Cigna Commercial	$4,256.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,059.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,276.83

RETENTIVE POLY LINER +6

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688884
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETENTIVE POLY LINER +6

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688884
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$1,908.08
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETENTIVE POLY LINER +9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688780
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$1,908.08
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETENTIVE POLY LINER +9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688780
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETEPLASE 10 UNITS INJ KIT

Facility

$8,976.90

Hospital Charge Code	60629268
Hospital Revenue Code	636
Min. Negotiated Rate	$1,346.54
Max. Negotiated Rate	$2,172.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,172.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.54

RETEPLASE 10 UNITS INJ KIT

Facility

$8,976.90

Hospital Charge Code	60629268
Hospital Revenue Code	636
Min. Negotiated Rate	$1,346.54
Max. Negotiated Rate	$4,488.45
Rate for Payer: Aetna Commercial	$2,693.07
Rate for Payer: Aetna Medicare Advantage	$2,693.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,289.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,289.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,289.11
Rate for Payer: Cigna Commercial	$4,488.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,172.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.54

RETEPLASE 20U INJ

Facility

$14,362.50

Hospital Charge Code	60628785
Hospital Revenue Code	636
Min. Negotiated Rate	$2,154.38
Max. Negotiated Rate	$7,181.25
Rate for Payer: Aetna Commercial	$4,308.75
Rate for Payer: Aetna Medicare Advantage	$4,308.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,662.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,662.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,662.44
Rate for Payer: Cigna Commercial	$7,181.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,475.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,154.38

RETEPLASE 20U INJ

Facility

$14,362.50

Hospital Charge Code	60628785
Hospital Revenue Code	636
Min. Negotiated Rate	$2,154.38
Max. Negotiated Rate	$3,475.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,475.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,154.38

RETEPLASE INJ 20 U

Facility

$6,051.00

Hospital Charge Code	60635242
Hospital Revenue Code	636
Min. Negotiated Rate	$907.65
Max. Negotiated Rate	$3,025.50
Rate for Payer: Aetna Commercial	$1,815.30
Rate for Payer: Aetna Medicare Advantage	$1,815.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,543.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,543.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,543.01
Rate for Payer: Cigna Commercial	$3,025.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.34
Rate for Payer: Qualcare PPO/HMO/WC	$907.65

Know your out-of-pocket cost for care.

All Charges