Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAPSUCTMY W RELS HIP FLEX MSCL

Facility

$1,457.75

Service Code	HCPCS 11402
Hospital Charge Code	16000704
Hospital Revenue Code	360
Min. Negotiated Rate	$218.66
Max. Negotiated Rate	$218.66
Rate for Payer: Qualcare PPO/HMO/WC	$218.66

CAPSUCTMY W RELS HIP FLEX MSCL

Facility

$1,457.75

Service Code	HCPCS 11402
Hospital Charge Code	16000704
Hospital Revenue Code	360
Min. Negotiated Rate	$189.51
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$437.32
Rate for Payer: Aetna Medicare Advantage	$437.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$371.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$371.73
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	$371.73
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.51
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$218.66
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CAPSULE FM G3

Facility

$3,175.00

Hospital Charge Code	270683733
Hospital Revenue Code	272
Min. Negotiated Rate	$476.25
Max. Negotiated Rate	$476.25
Rate for Payer: Qualcare PPO/HMO/WC	$476.25

CAPSULE FM G3

Facility

$3,175.00

Hospital Charge Code	270683733
Hospital Revenue Code	272
Min. Negotiated Rate	$412.75
Max. Negotiated Rate	$1,587.50
Rate for Payer: Aetna Commercial	$952.50
Rate for Payer: Aetna Medicare Advantage	$952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$809.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$809.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$809.62
Rate for Payer: Cigna Commercial	$1,587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.75
Rate for Payer: Oxford Commercial	$1,587.50
Rate for Payer: Qualcare PPO/HMO/WC	$476.25
Rate for Payer: UnitedHealthcare Commercial	$1,587.50

CAPSULE POLISHER

Facility

$52.00

Hospital Charge Code	270335190
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

CAPSULE POLISHER

Facility

$52.00

Hospital Charge Code	270335190
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

CAPSULOTOMY; IP JNT SGL EA JOI

Facility

$6,728.28

Service Code	HCPCS 28272
Hospital Charge Code	16000264
Hospital Revenue Code	360
Min. Negotiated Rate	$1,009.24
Max. Negotiated Rate	$1,009.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24

CAPSULOTOMY; IP JNT SGL EA JOI

Facility

$6,728.28

Service Code	HCPCS 28272
Hospital Charge Code	16000264
Hospital Revenue Code	360
Min. Negotiated Rate	$874.68
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,018.48
Rate for Payer: Aetna Medicare Advantage	$2,018.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,715.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,715.71
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	$1,715.71
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.68
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CAPSURE

Facility

$3,150.00

Hospital Charge Code	270685690
Hospital Revenue Code	272
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.50
Rate for Payer: Oxford Commercial	$1,575.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Commercial	$1,575.00

CAPSURE

Facility

$3,150.00

Hospital Charge Code	270685690
Hospital Revenue Code	272
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

CAPSURE FIXATION SYSTEM

Facility

$2,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270686021
Hospital Revenue Code	278
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$496.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

CAPSURE FIXATION SYSTEM

Facility

$2,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270686021
Hospital Revenue Code	278
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$615.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

CAP SURGEON BLUE 69196

Facility

$76.48

Hospital Charge Code	270060205C
Hospital Revenue Code	272
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$11.47
Rate for Payer: Qualcare PPO/HMO/WC	$11.47

CAP SURGEON BLUE 69196

Facility

$76.48

Hospital Charge Code	270060205C
Hospital Revenue Code	272
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$38.24
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.50
Rate for Payer: Cigna Commercial	$38.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.94
Rate for Payer: Oxford Commercial	$38.24
Rate for Payer: Qualcare PPO/HMO/WC	$11.47
Rate for Payer: UnitedHealthcare Commercial	$38.24

CAP SURGEON BLUE DISP

Facility

$0.23

Hospital Charge Code	270648968
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.03

CAP SURGEON BLUE DISP

Facility

$0.23

Hospital Charge Code	270648968
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna Commercial	$0.07
Rate for Payer: Aetna Medicare Advantage	$0.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.06
Rate for Payer: Cigna Commercial	$0.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.03
Rate for Payer: Oxford Commercial	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.03
Rate for Payer: UnitedHealthcare Commercial	$0.12

CAP SYN K WIRE PTCT 2.5 392.24

Facility

$11.25

Hospital Charge Code	270601819
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

CAP SYN K WIRE PTCT 2.5 392.24

Facility

$11.25

Hospital Charge Code	270601819
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

CAP TELCO INJ****

Facility

$9.00

Hospital Charge Code	7000540
Hospital Revenue Code	279
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

CAP TELCO INJ****

Facility

$9.00

Hospital Charge Code	7000540
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CAPTIVATOR EMR DEVICE

Facility

$1,626.05

Hospital Charge Code	270688074
Hospital Revenue Code	272
Min. Negotiated Rate	$211.39
Max. Negotiated Rate	$813.02
Rate for Payer: Aetna Commercial	$487.81
Rate for Payer: Aetna Medicare Advantage	$487.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.64
Rate for Payer: Cigna Commercial	$813.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.39
Rate for Payer: Oxford Commercial	$813.02
Rate for Payer: Qualcare PPO/HMO/WC	$243.91
Rate for Payer: UnitedHealthcare Commercial	$813.02

CAPTIVATOR EMR DEVICE

Facility

$1,626.05

Hospital Charge Code	270688074
Hospital Revenue Code	272
Min. Negotiated Rate	$243.91
Max. Negotiated Rate	$243.91
Rate for Payer: Qualcare PPO/HMO/WC	$243.91

CAPTOPRIL 12.5 MG TAB

Facility

$9.65

Hospital Charge Code	60627549
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

CAPTOPRIL 12.5 MG TAB

Facility

$9.65

Hospital Charge Code	60627549
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

CAPTOPRIL 12.5MG TAB

Facility

$44.70

Hospital Charge Code	6063943072
Hospital Revenue Code	250
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$6.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.71

Know your out-of-pocket cost for care.

All Charges