Heights University Hospital

All Charges

Charge

Type

Setting

Price

SACCOMANNO CELL TRANS SYS

Facility

$20.00

Hospital Charge Code	270657259
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

SACCOMANNO CELL TRANS SYS

Facility

$20.00

Hospital Charge Code	270657259
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$10.00

SA COVER PLATE, LARGE

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705952
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

SA COVER PLATE, LARGE

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705952
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

SACRUM AND COCCYX

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	94061101
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$242.34
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19

SACRUM AND COCCYX

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	94061101
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SACUBITRAL/VALSARTAN 97/103 MG

Facility

$46.03

Service Code	NDC 78069635
Hospital Charge Code	606390144
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

SACUBITRAL/VALSARTAN 97/103 MG

Facility

$46.03

Service Code	NDC 78069635
Hospital Charge Code	606390144
Hospital Revenue Code	250
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$23.02
Rate for Payer: Aetna Commercial	$13.81
Rate for Payer: Aetna Medicare Advantage	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.74
Rate for Payer: Cigna Commercial	$23.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Oxford Commercial	$23.02
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$23.02

SACUBITRIL/VALSARTAN 24-26mg

Facility

$108.41

Service Code	NDC 78065920
Hospital Charge Code	606390104
Hospital Revenue Code	250
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$32.52
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.09
Rate for Payer: Oxford Commercial	$54.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$54.20

SACUBITRIL/VALSARTAN 24-26mg

Facility

$108.41

Service Code	NDC 78065920
Hospital Charge Code	606390104
Hospital Revenue Code	250
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SACUBITRIL/VALSARTAN 49-51mg

Facility

$108.41

Service Code	NDC 78077720
Hospital Charge Code	606390105
Hospital Revenue Code	250
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$32.52
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.09
Rate for Payer: Oxford Commercial	$54.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$54.20

SACUBITRIL/VALSARTAN 49-51mg

Facility

$108.41

Service Code	NDC 78077720
Hospital Charge Code	606390105
Hospital Revenue Code	250
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SAFEGUARD 24CM

Facility

$29.50

Hospital Charge Code	2709006961
Hospital Revenue Code	272
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$14.75
Rate for Payer: Aetna Commercial	$8.85
Rate for Payer: Aetna Medicare Advantage	$8.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.52
Rate for Payer: Cigna Commercial	$14.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.83
Rate for Payer: Oxford Commercial	$14.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.42
Rate for Payer: UnitedHealthcare Commercial	$14.75

SAFEGUARD 24CM

Facility

$29.50

Hospital Charge Code	2709006961
Hospital Revenue Code	272
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.42

SAFEGUARD 24CM

Facility

$295.00

Hospital Charge Code	270657684
Hospital Revenue Code	270
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

SAFEGUARD 24CM

Facility

$295.00

Hospital Charge Code	270657684
Hospital Revenue Code	270
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$147.50
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$147.50

SAFEGUARD PRESSURE ASSIST DEV

Facility

$245.00

Hospital Charge Code	270669756
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

SAFEGUARD PRESSURE ASSIST DEV

Facility

$245.00

Hospital Charge Code	270669756N
Hospital Revenue Code	272
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$73.50
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.85
Rate for Payer: Oxford Commercial	$122.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$122.50

SAFEGUARD PRESSURE ASSIST DEV

Facility

$245.00

Hospital Charge Code	270669756
Hospital Revenue Code	272
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$73.50
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.85
Rate for Payer: Oxford Commercial	$122.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$122.50

SAFEGUARD PRESSURE ASSIST DEV

Facility

$245.00

Hospital Charge Code	270669756N
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

SAFESHEATH II 6FR W/SIDEPORT

Facility

$250.00

Hospital Charge Code	270678659S
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SAFESHEATH II 6FR W/SIDEPORT

Facility

$250.00

Hospital Charge Code	270678659S
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

SAFESHEATH II 6FR W/SIDEPORT

Facility

$250.00

Hospital Charge Code	270678659
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SAFESHEATH II 6FR W/SIDEPORT

Facility

$250.00

Hospital Charge Code	270678659
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

SAFESHEATH II 7FR W/SIDEPORT

Facility

$250.00

Service Code	HCPCS C1894
Hospital Charge Code	270675044
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges