Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAPROSYN* 0 UNDYED 36 GS-21

Facility

$7.05

Hospital Charge Code	270657585
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$2.12
Rate for Payer: Aetna Medicare Advantage	$2.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.80
Rate for Payer: Cigna Commercial	$3.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.92
Rate for Payer: Oxford Commercial	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$1.06
Rate for Payer: UnitedHealthcare Commercial	$3.52

CAPROSYN 2-0 UNDYED 36

Facility

$8.34

Hospital Charge Code	270651122
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

CAPROSYN 2-0 UNDYED 36

Facility

$8.34

Hospital Charge Code	270651122
Hospital Revenue Code	270
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare Advantage	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.13
Rate for Payer: Cigna Commercial	$4.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.08
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$4.17

CAPS

Facility

$875.00

Hospital Charge Code	270659159
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPS

Facility

$875.00

Hospital Charge Code	270669468
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.75
Rate for Payer: Oxford Commercial	$437.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$437.50

CAPS

Facility

$875.00

Hospital Charge Code	270659159
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPS

Facility

$875.00

Hospital Charge Code	270669468
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPSAICIN 0.025% CREAM

Facility

$1.95

Hospital Charge Code	6007322
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

CAPSAICIN 0.025% CREAM

Facility

$1.95

Hospital Charge Code	6007322
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CAPSAICIN 0.075% CRE

Facility

$181.65

Hospital Charge Code	60628411
Hospital Revenue Code	250
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$90.83
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$90.83
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$90.83

CAPSAICIN 0.075% CRE

Facility

$181.65

Hospital Charge Code	60628411
Hospital Revenue Code	250
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CAPSAICIN 0.1% CREAM

Facility

$102.04

Service Code	NDC 41167075142
Hospital Charge Code	606390225
Hospital Revenue Code	250
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$30.61
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.27
Rate for Payer: Oxford Commercial	$51.02
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$51.02

CAPSAICIN 0.1% CREAM

Facility

$102.04

Service Code	NDC 41167075142
Hospital Charge Code	606390225
Hospital Revenue Code	250
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

CAP SCREW ASSEMBLY

Facility

$1,025.00

Hospital Charge Code	270671062
Hospital Revenue Code	272
Min. Negotiated Rate	$133.25
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$307.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.25
Rate for Payer: Oxford Commercial	$512.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$512.50

CAP SCREW ASSEMBLY

Facility

$1,025.00

Hospital Charge Code	270671062
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CAP SCREW LOCKING

Facility

$995.00

Service Code	HCPCS C1713
Hospital Charge Code	270691932
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$298.50
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CAP SCREW LOCKING

Facility

$995.00

Service Code	HCPCS C1713
Hospital Charge Code	270691932
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CAPS DEPUY 1770.91.060

Facility

$1,388.85

Hospital Charge Code	270629834
Hospital Revenue Code	272
Min. Negotiated Rate	$208.33
Max. Negotiated Rate	$208.33
Rate for Payer: Qualcare PPO/HMO/WC	$208.33

CAPS DEPUY 1770.91.060

Facility

$1,388.85

Hospital Charge Code	270629834
Hospital Revenue Code	272
Min. Negotiated Rate	$180.55
Max. Negotiated Rate	$694.42
Rate for Payer: Aetna Commercial	$416.65
Rate for Payer: Aetna Medicare Advantage	$416.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.16
Rate for Payer: Cigna Commercial	$694.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.55
Rate for Payer: Oxford Commercial	$694.42
Rate for Payer: Qualcare PPO/HMO/WC	$208.33
Rate for Payer: UnitedHealthcare Commercial	$694.42

CAPS LOCKING LINEUM

Facility

$1,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693060
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CAPS LOCKING LINEUM

Facility

$1,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693060
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CAPS SINGLE INNER SETSCREW

Facility

$1,775.00

Hospital Charge Code	270667360
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$429.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CAPS SINGLE INNER SETSCREW

Facility

$1,775.00

Hospital Charge Code	270667360
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$887.50
Rate for Payer: Aetna Commercial	$532.50
Rate for Payer: Aetna Medicare Advantage	$532.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.62
Rate for Payer: Cigna Commercial	$887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CAP SUCTION

Facility

$222.45

Hospital Charge Code	270676863
Hospital Revenue Code	272
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$111.22
Rate for Payer: Aetna Commercial	$66.73
Rate for Payer: Aetna Medicare Advantage	$66.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.72
Rate for Payer: Cigna Commercial	$111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.92
Rate for Payer: Oxford Commercial	$111.22
Rate for Payer: Qualcare PPO/HMO/WC	$33.37
Rate for Payer: UnitedHealthcare Commercial	$111.22

CAP SUCTION

Facility

$222.45

Hospital Charge Code	270676863
Hospital Revenue Code	272
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$33.37
Rate for Payer: Qualcare PPO/HMO/WC	$33.37

Know your out-of-pocket cost for care.

All Charges