Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW SYN CORT 3.5 45MM 204.45

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270604218
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SCREW SYN CORT 3.5 45MM 204.45

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270604218
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SCREW SYN CORT 3.5 50MM 204.50

Facility

$67.25

Hospital Charge Code	270604219
Hospital Revenue Code	278
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$16.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SCREW SYN CORT 3.5 50MM 204.50

Facility

$67.25

Hospital Charge Code	270604219
Hospital Revenue Code	278
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SCREW SYN CORT 3.5 55MM 204.55

Facility

$67.25

Hospital Charge Code	270604220
Hospital Revenue Code	278
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SCREW SYN CORT 3.5 55MM 204.55

Facility

$67.25

Hospital Charge Code	270604220
Hospital Revenue Code	278
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$16.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SCREW SYN CORT 3.5 60MM 204.60

Facility

$99.25

Hospital Charge Code	270604221
Hospital Revenue Code	278
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$49.62
Rate for Payer: Aetna Commercial	$29.77
Rate for Payer: Aetna Medicare Advantage	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.31
Rate for Payer: Cigna Commercial	$49.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.89

SCREW SYN CORT 3.5 60MM 204.60

Facility

$99.25

Hospital Charge Code	270604221
Hospital Revenue Code	278
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$24.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.89

SCREW SYN CORT 3.5 65MM 204.65

Facility

$100.85

Hospital Charge Code	270604222
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 65MM 204.65

Facility

$100.85

Hospital Charge Code	270604222
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$24.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 70MM 204.70

Facility

$100.85

Hospital Charge Code	270604223
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$24.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 70MM 204.70

Facility

$100.85

Hospital Charge Code	270604223
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 75MM 204.75

Facility

$100.85

Hospital Charge Code	270604224
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$24.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 75MM 204.75

Facility

$100.85

Hospital Charge Code	270604224
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 80MM 204.80

Facility

$100.85

Hospital Charge Code	270604225
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 80MM 204.80

Facility

$100.85

Hospital Charge Code	270604225
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$24.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 85MM 204.85

Facility

$100.85

Hospital Charge Code	270604226
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 85MM 204.85

Facility

$100.85

Hospital Charge Code	270604226
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$24.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 90MM 204.90

Facility

$76.85

Hospital Charge Code	270604227
Hospital Revenue Code	278
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

SCREW SYN CORT 3.5 90MM 204.90

Facility

$76.85

Hospital Charge Code	270604227
Hospital Revenue Code	278
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$38.42
Rate for Payer: Aetna Commercial	$23.05
Rate for Payer: Aetna Medicare Advantage	$23.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.60
Rate for Payer: Cigna Commercial	$38.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

SCREW SYN CORT 3.5 95MM 204.95

Facility

$100.85

Hospital Charge Code	270604228
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$24.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 3.5 95MM 204.95

Facility

$100.85

Hospital Charge Code	270604228
Hospital Revenue Code	278
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SCREW SYN CORT 4.5 100 214.100

Facility

$111.25

Hospital Charge Code	270603755
Hospital Revenue Code	278
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$33.38
Rate for Payer: Aetna Medicare Advantage	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.37
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

SCREW SYN CORT 4.5 100 214.100

Facility

$111.25

Hospital Charge Code	270603755
Hospital Revenue Code	278
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$26.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

SCREW SYN CORT 4.5 14MM 214.14

Facility

$67.25

Hospital Charge Code	270603628
Hospital Revenue Code	278
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$16.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

Know your out-of-pocket cost for care.

All Charges