Heights University Hospital

All Charges

Charge

Type

Setting

Price

SELF DRILLING SCREW 3.5X15MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703995
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SELF DRILLING SCREW 3.5X15MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703995
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SELF DRILLING SCREW. 3.8X14MM

Facility

$2,500.00

Hospital Charge Code	270702107
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

SELF DRILLING SCREW. 3.8X14MM

Facility

$2,500.00

Hospital Charge Code	270702107
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

SELF DRILL SCREW 4.0 X 14MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687501
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SELF DRILL SCREW 4.0 X 14MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687501
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SELF PUNCH KNOTLESS 2.6MM FIBE

Facility

$2,317.50

Service Code	HCPCS C1713
Hospital Charge Code	270704695
Hospital Revenue Code	278
Min. Negotiated Rate	$347.62
Max. Negotiated Rate	$560.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$463.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.84
Rate for Payer: Qualcare PPO/HMO/WC	$347.62

SELF PUNCH KNOTLESS 2.6MM FIBE

Facility

$2,317.50

Service Code	HCPCS C1713
Hospital Charge Code	270704695
Hospital Revenue Code	278
Min. Negotiated Rate	$347.62
Max. Negotiated Rate	$1,158.75
Rate for Payer: Cigna Commercial	$1,158.75
Rate for Payer: Aetna Commercial	$695.25
Rate for Payer: Aetna Medicare Advantage	$695.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$590.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$590.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$590.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.84
Rate for Payer: Qualcare PPO/HMO/WC	$347.62

SELF SEAL CAP FOR GYNECOLOG

Facility

$49.40

Hospital Charge Code	270659399
Hospital Revenue Code	272
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$14.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.60
Rate for Payer: Cigna Commercial	$24.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.42
Rate for Payer: Oxford Commercial	$24.70
Rate for Payer: Qualcare PPO/HMO/WC	$7.41
Rate for Payer: UnitedHealthcare Commercial	$24.70

SELF SEAL CAP FOR GYNECOLOG

Facility

$49.40

Hospital Charge Code	270659399
Hospital Revenue Code	272
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$7.41

SELF TAP 16MM

Facility

$1,258.75

Service Code	HCPCS C1713
Hospital Charge Code	270689230
Hospital Revenue Code	278
Min. Negotiated Rate	$188.81
Max. Negotiated Rate	$629.38
Rate for Payer: Aetna Commercial	$377.62
Rate for Payer: Aetna Medicare Advantage	$377.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.98
Rate for Payer: Cigna Commercial	$629.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.62
Rate for Payer: Qualcare PPO/HMO/WC	$188.81

SELF TAP 16MM

Facility

$1,258.75

Service Code	HCPCS C1713
Hospital Charge Code	270689230
Hospital Revenue Code	278
Min. Negotiated Rate	$188.81
Max. Negotiated Rate	$304.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.62
Rate for Payer: Qualcare PPO/HMO/WC	$188.81

SELF TAP SCREW 4X16MM

Facility

$875.00

Hospital Charge Code	270703079
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

SELF TAP SCREW 4X16MM

Facility

$875.00

Hospital Charge Code	270703079
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

SELSUN 2.5%/120ML

Facility

$66.00

Hospital Charge Code	60633860
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SELSUN 2.5%/120ML

Facility

$66.00

Hospital Charge Code	60633860
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

SELSUN BLUE 1%/120ML

Facility

$23.00

Hospital Charge Code	60633859
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

SELSUN BLUE 1%/120ML

Facility

$23.00

Hospital Charge Code	60633859
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

SELZENTRY 150MG TAB

Facility

$80.00

Hospital Charge Code	60635697
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

SELZENTRY 150MG TAB

Facility

$80.00

Hospital Charge Code	60635697
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

SEMEN ANALYSIS

Facility

$390.00

Service Code	HCPCS 89320
Hospital Charge Code	3004058
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEMEN ANALYSIS

Facility

$390.00

Service Code	HCPCS 89320
Hospital Charge Code	3004058
Hospital Revenue Code	300
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.88
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$12.31
Rate for Payer: Cigna Medicare Advantage	$6.16
Rate for Payer: Clover Medicare Advantage	$11.69
Rate for Payer: EmblemHealth Commercial	$36.93
Rate for Payer: Humana Medicare Advantage	$12.68
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	$12.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.05
Rate for Payer: Wellcare Medicare Advantage	$12.31

SEMEN ANALYSIS, COMPLETE

Facility

$790.00

Service Code	HCPCS 89320
Hospital Charge Code	38473033
Hospital Revenue Code	309
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

SEMEN ANALYSIS, COMPLETE

Facility

$790.00

Service Code	HCPCS 89320
Hospital Charge Code	38473033
Hospital Revenue Code	309
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$39.88
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$12.31
Rate for Payer: Cigna Medicare Advantage	$6.16
Rate for Payer: Clover Medicare Advantage	$11.69
Rate for Payer: EmblemHealth Commercial	$36.93
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.05
Rate for Payer: Wellcare Medicare Advantage	$12.31

SEMEN ANALYSIS, PRESENCE

Facility

$85.00

Service Code	HCPCS 89321
Hospital Charge Code	38473034
Hospital Revenue Code	309
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

Know your out-of-pocket cost for care.

All Charges