Heights University Hospital

All Charges

Charge

Type

Setting

Price

TXMENT OF ANKLE FRACTURE LT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	1600000875
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$14,697.63
Rate for Payer: Aetna Medicare Advantage	$14,697.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,492.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,492.99
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	$12,492.99
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,368.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

TXMENT OF ANKLE FRACTURE LT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	1600000875
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

TXMENT OF ANKLE FRACTURE-RT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	16000317
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

TXMENT OF ANKLE FRACTURE-RT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	16000317
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$14,697.63
Rate for Payer: Aetna Medicare Advantage	$14,697.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,492.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,492.99
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	$12,492.99
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,368.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

TX SPONTAN HIP DISLOC W ANESTH

Facility

$6,353.84

Service Code	HCPCS 27257
Hospital Charge Code	16000873
Hospital Revenue Code	360
Min. Negotiated Rate	$953.08
Max. Negotiated Rate	$953.08
Rate for Payer: Qualcare PPO/HMO/WC	$953.08

TX SPONTAN HIP DISLOC W ANESTH

Facility

$6,353.84

Service Code	HCPCS 27257
Hospital Charge Code	16000873
Hospital Revenue Code	360
Min. Negotiated Rate	$826.00
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,906.15
Rate for Payer: Aetna Medicare Advantage	$1,906.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.23
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	$1,620.23
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$953.08
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

TX S WND DEHISC; SMPL

Facility

$4,862.70

Service Code	HCPCS 12020
Hospital Charge Code	1600000502
Hospital Revenue Code	360
Min. Negotiated Rate	$729.40
Max. Negotiated Rate	$729.40
Rate for Payer: Qualcare PPO/HMO/WC	$729.40

TX S WND DEHISC; SMPL

Facility

$4,862.70

Service Code	HCPCS 12020
Hospital Charge Code	1600000502
Hospital Revenue Code	360
Min. Negotiated Rate	$632.15
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,458.81
Rate for Payer: Aetna Medicare Advantage	$1,458.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,239.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,239.99
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	$1,239.99
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.15
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$729.40
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TYLENOL CHILDRENS/100MG/1

Facility

$7.00

Hospital Charge Code	60634100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

TYLENOL CHILDRENS/100MG/1

Facility

$7.00

Hospital Charge Code	60634100
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TYLENOL ELX

Facility

$21.15

Hospital Charge Code	6008288
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

TYLENOL ELX

Facility

$21.15

Hospital Charge Code	6008288
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

TYLENOL EXTRA STRENG LIQ

Facility

$21.00

Hospital Charge Code	60634818
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

TYLENOL EXTRA STRENG LIQ

Facility

$21.00

Hospital Charge Code	60634818
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

TYLENOL EXTRA STRENGTH/50

Facility

$3.00

Hospital Charge Code	60634102
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TYLENOL EXTRA STRENGTH/50

Facility

$1.00

Hospital Charge Code	60634101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TYLENOL EXTRA STRENGTH/50

Facility

$1.00

Hospital Charge Code	60634103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

TYLENOL EXTRA STRENGTH/50

Facility

$1.00

Hospital Charge Code	60634103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TYLENOL EXTRA STRENGTH/50

Facility

$3.00

Hospital Charge Code	60634102
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

TYLENOL EXTRA STRENGTH/50

Facility

$1.00

Hospital Charge Code	60634101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

TYLENOL FOR CHILDREN/160M

Facility

$3.00

Hospital Charge Code	60634105
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

TYLENOL FOR CHILDREN/160M

Facility

$3.00

Hospital Charge Code	60634105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TYLENOL GTTS

Facility

$21.15

Hospital Charge Code	6008296
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

TYLENOL GTTS

Facility

$21.15

Hospital Charge Code	6008296
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

Tylenol no 2

Facility

$1.76

Hospital Charge Code	6063943297
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.88
Rate for Payer: Aetna Commercial	$0.53
Rate for Payer: Aetna Medicare Advantage	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.45
Rate for Payer: Cigna Commercial	$0.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.23
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.26
Rate for Payer: UnitedHealthcare Commercial	$0.88

Know your out-of-pocket cost for care.

All Charges