Heights University Hospital

All Charges

Charge

Type

Setting

Price

TENOTMY OP FLEXOR,TOE SINGLE

Facility

$21,066.25

Service Code	HCPCS 28232
Hospital Charge Code	16000416
Hospital Revenue Code	360
Min. Negotiated Rate	$3,159.94
Max. Negotiated Rate	$3,159.94
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.94

TENOTOMY HIP FLEXOR(S) OPEN

Facility

$29,369.08

Service Code	HCPCS 27005
Hospital Charge Code	1600000576
Hospital Revenue Code	360
Min. Negotiated Rate	$4,405.36
Max. Negotiated Rate	$4,405.36
Rate for Payer: Qualcare PPO/HMO/WC	$4,405.36

TENOTOMY HIP FLEXOR(S) OPEN

Facility

$29,369.08

Service Code	HCPCS 27005
Hospital Charge Code	1600000576
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$8,810.72
Rate for Payer: Aetna Medicare Advantage	$8,810.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,489.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,489.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,489.12
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,817.98
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,405.36
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

TENOTOMY OP FLEXOR,FT SGL/MULT

Facility

$19,998.60

Service Code	HCPCS 28230
Hospital Charge Code	16000634
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

TENOTOMY OP FLEXOR,FT SGL/MULT

Facility

$19,998.60

Service Code	HCPCS 28230
Hospital Charge Code	16000634
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,999.58
Rate for Payer: Aetna Commercial	$5,999.58
Rate for Payer: Aetna Medicare Advantage	$5,999.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,099.64
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,599.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

TENOTOMY SQ TOE,SINGLE T9

Facility

$19,998.60

Service Code	HCPCS 28010
Hospital Charge Code	16000903
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,999.58
Rate for Payer: Aetna Commercial	$5,999.58
Rate for Payer: Aetna Medicare Advantage	$5,999.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,099.64
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,599.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

TENOTOMY SQ TOE,SINGLE T9

Facility

$19,998.60

Service Code	HCPCS 28010
Hospital Charge Code	16000903
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

TENSILON/10MG/1ML

Facility

$18.00

Hospital Charge Code	60633989
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TENSILON/10MG/1ML

Facility

$18.00

Hospital Charge Code	60633989
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

TENSIX DBM 10CC

Facility

$18,325.00

Service Code	HCPCS Q4146
Hospital Charge Code	270694926
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$5,497.50
Rate for Payer: Aetna Commercial	$5,497.50
Rate for Payer: Aetna Medicare Advantage	$5,497.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,672.88
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75

TENSIX DBM 10CC

Facility

$18,325.00

Service Code	HCPCS Q4146
Hospital Charge Code	270694926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,748.75
Max. Negotiated Rate	$4,434.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75

TENSIX DBM COMP 10CC

Facility

$18,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270694902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,748.75
Max. Negotiated Rate	$9,162.50
Rate for Payer: Aetna Commercial	$5,497.50
Rate for Payer: Aetna Medicare Advantage	$5,497.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,672.88
Rate for Payer: Cigna Commercial	$9,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75

TENSIX DBM COMP 10CC

Facility

$18,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270694902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,748.75
Max. Negotiated Rate	$4,434.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75

TENT*******

Facility

$43.20

Hospital Charge Code	9500331
Hospital Revenue Code	279
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$6.48
Rate for Payer: Qualcare PPO/HMO/WC	$6.48

TENT*******

Facility

$43.20

Hospital Charge Code	9500331
Hospital Revenue Code	279
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$12.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.02
Rate for Payer: Cigna Commercial	$21.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.48
Rate for Payer: UnitedHealthcare Commercial	$21.60

TENT CONTINUOUS***

Facility

$72.60

Service Code	HCPCS 94665
Hospital Charge Code	9500471
Hospital Revenue Code	419
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$10.89

TENT CONTINUOUS***

Facility

$72.60

Service Code	HCPCS 94665
Hospital Charge Code	9500471
Hospital Revenue Code	419
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$21.78
Rate for Payer: Aetna Medicare Advantage	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.51
Rate for Payer: Cigna Commercial	$36.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.44
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.89
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

TENT PRN***

Facility

$44.00

Service Code	HCPCS 94664
Hospital Charge Code	9500489
Hospital Revenue Code	419
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

TENT PRN***

Facility

$44.00

Service Code	HCPCS 94664
Hospital Charge Code	9500489
Hospital Revenue Code	419
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

TEQUIN 200MG/100ML PREMIX

Facility

$85.00

Hospital Charge Code	60635338
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$42.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$42.50

TEQUIN 200MG/100ML PREMIX

Facility

$85.00

Hospital Charge Code	60635338
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

TEQUIN 200MG/20ML VIAL

Facility

$79.00

Hospital Charge Code	60635290
Hospital Revenue Code	636
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$23.70
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

TEQUIN 200MG/20ML VIAL

Facility

$79.00

Hospital Charge Code	60635290
Hospital Revenue Code	636
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$19.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

TEQUIN 200MG U/D TAB

Facility

$26.00

Hospital Charge Code	60635291
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

TEQUIN 200MG U/D TAB

Facility

$26.00

Hospital Charge Code	60635291
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

Know your out-of-pocket cost for care.

All Charges