Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAFFEINE-SODIUM 250MG/ML 2ML I

Facility

$144.85

Hospital Charge Code	60628780
Hospital Revenue Code	250
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$72.42
Rate for Payer: Aetna Commercial	$43.45
Rate for Payer: Aetna Medicare Advantage	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.94
Rate for Payer: Cigna Commercial	$72.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.83
Rate for Payer: Oxford Commercial	$72.42
Rate for Payer: Qualcare PPO/HMO/WC	$21.73
Rate for Payer: UnitedHealthcare Commercial	$72.42

CAFFEINE TAB 100MG

Facility

$3.20

Hospital Charge Code	60628580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

CAFFEINE TAB 100MG

Facility

$3.20

Hospital Charge Code	60628580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

CAFF & SODIUM BENZOATE 0.5/2ML

Facility

$41.60

Hospital Charge Code	6016554
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

CAFF & SODIUM BENZOATE 0.5/2ML

Facility

$41.60

Hospital Charge Code	6016554
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

CAGE 10MM X-WIDE

Facility

$16,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270688899
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$3,908.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50

CAGE 10MM X-WIDE

Facility

$16,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270688899
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$8,075.00
Rate for Payer: Aetna Commercial	$4,845.00
Rate for Payer: Aetna Medicare Advantage	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,118.25
Rate for Payer: Cigna Commercial	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50

CAGE 10X24X11MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705930
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10X24X11MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705930
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10X24X8MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10X24X8MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,999.00
Max. Negotiated Rate	$6,451.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00

CAGE 10 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,999.00
Max. Negotiated Rate	$13,330.00
Rate for Payer: Aetna Commercial	$7,998.00
Rate for Payer: Aetna Medicare Advantage	$7,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,798.30
Rate for Payer: Cigna Commercial	$13,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00

CAGE 11X27X11MM

Facility

$13,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705993
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$3,900.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

CAGE 11X27X11MM

Facility

$13,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705993
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

CAGE 13MM 15DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705050
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 13MM 15DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705050
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 14X12X7MM 10DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705355
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 14X12X7MM 10DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705355
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 14X12X9MM 6DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705356
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 14X12X9MM 6DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705356
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 14X17X6

Facility

$35,505.00

Service Code	HCPCS C1889
Hospital Charge Code	270693295
Hospital Revenue Code	278
Min. Negotiated Rate	$5,325.75
Max. Negotiated Rate	$17,752.50
Rate for Payer: Aetna Commercial	$10,651.50
Rate for Payer: Aetna Medicare Advantage	$10,651.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,053.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,053.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,101.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,053.77
Rate for Payer: Cigna Commercial	$17,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,592.21
Rate for Payer: Qualcare PPO/HMO/WC	$5,325.75

CAGE 14X17X6

Facility

$35,505.00

Service Code	HCPCS C1889
Hospital Charge Code	270693295
Hospital Revenue Code	278
Min. Negotiated Rate	$5,325.75
Max. Negotiated Rate	$8,592.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,592.21
Rate for Payer: Qualcare PPO/HMO/WC	$5,325.75

CAGE 15MM 8DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705049
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 15MM 8DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705049
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

Know your out-of-pocket cost for care.

All Charges