Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAP LOCKING SCREW

Facility

$770.00

Service Code	HCPCS C1713
Hospital Charge Code	270691935
Hospital Revenue Code	278
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$186.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.34
Rate for Payer: Qualcare PPO/HMO/WC	$115.50

CAP LOCKING T25 VALENCIA PEDIC

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270694220
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CAP LOCKING T25 VALENCIA PEDIC

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270694220
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CAP MIS TULIP LKG CREO

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698436
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

CAP MIS TULIP LKG CREO

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698436
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

CAP MOD EPIPHYSIS SZ 1 R, HA

Facility

$25,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270686437
Hospital Revenue Code	278
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$12,600.00
Rate for Payer: Aetna Commercial	$7,560.00
Rate for Payer: Aetna Medicare Advantage	$7,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,426.00
Rate for Payer: Cigna Commercial	$12,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,780.00

CAP MOD EPIPHYSIS SZ 1 R, HA

Facility

$25,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270686437
Hospital Revenue Code	278
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$6,098.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,780.00

CAPNOLINE H 02 ADULT

Facility

$80.47

Hospital Charge Code	270668153
Hospital Revenue Code	272
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$12.07
Rate for Payer: Qualcare PPO/HMO/WC	$12.07

CAPNOLINE H 02 ADULT

Facility

$80.47

Hospital Charge Code	270668153
Hospital Revenue Code	272
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$40.23
Rate for Payer: Aetna Commercial	$24.14
Rate for Payer: Aetna Medicare Advantage	$24.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.52
Rate for Payer: Cigna Commercial	$40.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.46
Rate for Payer: Oxford Commercial	$40.23
Rate for Payer: Qualcare PPO/HMO/WC	$12.07
Rate for Payer: UnitedHealthcare Commercial	$40.23

CAP ONE SEAL REDUCR 229901SEAL

Facility

$16.40

Hospital Charge Code	270608811
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

CAP ONE SEAL REDUCR 229901SEAL

Facility

$16.40

Hospital Charge Code	270608811
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$8.20
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Aetna Medicare Advantage	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.18
Rate for Payer: Cigna Commercial	$8.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.13
Rate for Payer: Oxford Commercial	$8.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$8.20

CAPOTEN/100MG/TAB

Facility

$6.00

Hospital Charge Code	60632614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CAPOTEN/100MG/TAB

Facility

$6.00

Hospital Charge Code	60632614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

CAPOTEN/12.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632608
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

CAPOTEN/12.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632609
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

CAPOTEN/12.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632608
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CAPOTEN/12.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632611
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

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CAPOTEN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60632610
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

CAPOTEN/50MG/TAB

Facility

$5.00

Hospital Charge Code	60632612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

CAPOTEN/50MG/TAB

Facility

$5.00

Hospital Charge Code	60632612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

CAPOTEN/50MG/TAB

Facility

$6.00

Hospital Charge Code	60632613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

CAPOTEN/50MG/TAB

Facility

$6.00

Hospital Charge Code	60632613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges