Heights University Hospital

All Charges

Charge

Type

Setting

Price

SYNTHES LOCKING SCREW 5.0 X 42

Facility

$951.70

Service Code	HCPCS C1713
Hospital Charge Code	270677266
Hospital Revenue Code	278
Min. Negotiated Rate	$142.75
Max. Negotiated Rate	$230.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.31
Rate for Payer: Qualcare PPO/HMO/WC	$142.75

SYNTHES LOCKING SCREW 5.0 X 46

Facility

$951.70

Service Code	HCPCS C1713
Hospital Charge Code	270645684
Hospital Revenue Code	278
Min. Negotiated Rate	$142.75
Max. Negotiated Rate	$475.85
Rate for Payer: Aetna Commercial	$285.51
Rate for Payer: Aetna Medicare Advantage	$285.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.68
Rate for Payer: Cigna Commercial	$475.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.31
Rate for Payer: Qualcare PPO/HMO/WC	$142.75

SYNTHES LOCKING SCREW 5.0 X 46

Facility

$951.70

Service Code	HCPCS C1713
Hospital Charge Code	270645684
Hospital Revenue Code	278
Min. Negotiated Rate	$142.75
Max. Negotiated Rate	$230.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.31
Rate for Payer: Qualcare PPO/HMO/WC	$142.75

SYNTHES MINI LOCK COLONEAL PLT

Facility

$997.50

Hospital Charge Code	270335984
Hospital Revenue Code	278
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$241.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

SYNTHES MINI LOCK COLONEAL PLT

Facility

$997.50

Hospital Charge Code	270335984
Hospital Revenue Code	278
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$299.25
Rate for Payer: Aetna Medicare Advantage	$299.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.36
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

SYNTHES THREADED GUID WIRE 2.5

Facility

$82.00

Hospital Charge Code	270335924
Hospital Revenue Code	278
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$19.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

SYNTHES THREADED GUID WIRE 2.5

Facility

$82.00

Hospital Charge Code	270335924
Hospital Revenue Code	278
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

SYNTHETIC BONE GRAFT 6CC

Facility

$10,750.00

Hospital Charge Code	270702209
Hospital Revenue Code	270
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$1,612.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SYNTHETIC BONE GRAFT 6CC

Facility

$10,750.00

Hospital Charge Code	270702209
Hospital Revenue Code	270
Min. Negotiated Rate	$1,397.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.50
Rate for Payer: Oxford Commercial	$5,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Commercial	$5,375.00

SYNTHROID/0.025/BULK

Facility

$4.00

Hospital Charge Code	60634686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SYNTHROID/0.025/BULK

Facility

$4.00

Hospital Charge Code	60634686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SYNTHROID/0.05/BULK

Facility

$3.00

Hospital Charge Code	60634687
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SYNTHROID/0.05/BULK

Facility

$3.00

Hospital Charge Code	60634687
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYNTHROID/0.05MG/TAB

Facility

$3.00

Hospital Charge Code	60633947
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SYNTHROID/0.05MG/TAB

Facility

$3.00

Hospital Charge Code	60633947
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYNTHROID/0.075/BULK

Facility

$3.00

Hospital Charge Code	60634688
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SYNTHROID/0.075/BULK

Facility

$3.00

Hospital Charge Code	60634688
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYNTHROID/0.125MG/TAB

Facility

$3.00

Hospital Charge Code	60633946
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SYNTHROID/0.125MG/TAB

Facility

$3.00

Hospital Charge Code	60633946
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYNTHROID/0.1MG/TAB

Facility

$3.00

Hospital Charge Code	60633949
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYNTHROID/0.1MG/TAB

Facility

$3.00

Hospital Charge Code	60633949
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SYNTHROID/0.2MG/TAB

Facility

$4.00

Hospital Charge Code	60633948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SYNTHROID/0.2MG/TAB

Facility

$4.00

Hospital Charge Code	60633948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SYNTHROID/0.3MG/BULK

Facility

$3.00

Hospital Charge Code	60634692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYNTHROID/0.3MG/BULK

Facility

$3.00

Hospital Charge Code	60634692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

Know your out-of-pocket cost for care.

All Charges