Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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) NJ Health	$50.00
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	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SAFESHEATH LONG 9FR 25cm

Facility

$675.00

Hospital Charge Code	270648889
Hospital Revenue Code	271
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.75
Rate for Payer: Oxford Commercial	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Commercial	$337.50

SAFESHEATH LONG 9FR 25cm

Facility

$675.00

Hospital Charge Code	270648889
Hospital Revenue Code	271
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

SAFETOUCH SYST W/O FILTER

Facility

$36.92

Hospital Charge Code	270649497
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$18.46
Rate for Payer: Aetna Commercial	$11.08
Rate for Payer: Aetna Medicare Advantage	$11.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$18.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Commercial	$18.46

SAFETOUCH SYST W/O FILTER

Facility

$36.92

Hospital Charge Code	270649497
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

SAFETY SEAL MIDAS REX

Facility

$335.00

Hospital Charge Code	270335562
Hospital Revenue Code	272
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$167.50
Rate for Payer: Aetna Commercial	$100.50
Rate for Payer: Aetna Medicare Advantage	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.42
Rate for Payer: Cigna Commercial	$167.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.55
Rate for Payer: Oxford Commercial	$167.50
Rate for Payer: Qualcare PPO/HMO/WC	$50.25
Rate for Payer: UnitedHealthcare Commercial	$167.50

SAFETY SEAL MIDAS REX

Facility

$335.00

Hospital Charge Code	270335562
Hospital Revenue Code	272
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

SAFEVIEW ENDOSCOP TISS REL SYS

Facility

$7,475.00

Hospital Charge Code	270694890
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

SAFEVIEW ENDOSCOP TISS REL SYS

Facility

$7,475.00

Hospital Charge Code	270694890
Hospital Revenue Code	272
Min. Negotiated Rate	$971.75
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.75
Rate for Payer: Oxford Commercial	$3,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$3,737.50

SAGE COMMODE-SPEC/COLLN*****

Facility

$10.00

Hospital Charge Code	8002818
Hospital Revenue Code	279
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

SAGE COMMODE-SPEC/COLLN*****

Facility

$10.00

Hospital Charge Code	8002818
Hospital Revenue Code	279
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

SAGITAL SAW THICK LONG

Facility

$695.00

Hospital Charge Code	270332571
Hospital Revenue Code	272
Min. Negotiated Rate	$90.35
Max. Negotiated Rate	$347.50
Rate for Payer: Aetna Commercial	$208.50
Rate for Payer: Aetna Medicare Advantage	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.22
Rate for Payer: Cigna Commercial	$347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.35
Rate for Payer: Oxford Commercial	$347.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.25
Rate for Payer: UnitedHealthcare Commercial	$347.50

SAGITAL SAW THICK LONG

Facility

$695.00

Hospital Charge Code	270332571
Hospital Revenue Code	272
Min. Negotiated Rate	$104.25
Max. Negotiated Rate	$104.25
Rate for Payer: Qualcare PPO/HMO/WC	$104.25

SAGITTAL BLADE 18.0 X 1.19 X90

Facility

$300.00

Hospital Charge Code	270687901
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$150.00

SAGITTAL BLADE 18.0 X 1.19 X90

Facility

$300.00

Hospital Charge Code	270687901
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SAGITTAL BLADE 25.0 X 1.27 X 9

Facility

$300.00

Hospital Charge Code	270650287
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SAGITTAL BLADE 25.0 X 1.27 X 9

Facility

$300.00

Hospital Charge Code	270650287
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$150.00

SAGITTAL BLADE 25MMX95MMX1.2MM

Facility

$265.00

Hospital Charge Code	270660097
Hospital Revenue Code	272
Min. Negotiated Rate	$34.45
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$79.50
Rate for Payer: Aetna Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.58
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.45
Rate for Payer: Oxford Commercial	$132.50
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$132.50

SAGITTAL BLADE 25MMX95MMX1.2MM

Facility

$265.00

Hospital Charge Code	270660097
Hospital Revenue Code	272
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

SAGITTAL SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674163
Hospital Revenue Code	272
Min. Negotiated Rate	$1,488.60
Max. Negotiated Rate	$1,488.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60

SAGITTAL SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674163
Hospital Revenue Code	272
Min. Negotiated Rate	$1,290.12
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$2,977.20
Rate for Payer: Aetna Medicare Advantage	$2,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.62
Rate for Payer: Cigna Commercial	$4,962.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,290.12
Rate for Payer: Oxford Commercial	$4,962.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60
Rate for Payer: UnitedHealthcare Commercial	$4,962.00

SALICYLATE, BLOOD (ASPIRIN)

Facility

$667.59

Service Code	HCPCS 80329
Hospital Charge Code	3002391
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SALICYLATE, BLOOD (ASPIRIN)

Facility

$667.59

Service Code	HCPCS 80329
Hospital Charge Code	3002391
Hospital Revenue Code	301
Min. Negotiated Rate	$86.79
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$200.28
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00

SALICYLATE,SERUM

Facility

$226.00

Service Code	HCPCS 80329
Hospital Charge Code	38472602
Hospital Revenue Code	301
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

SALICYLATE,SERUM

Facility

$226.00

Service Code	HCPCS 80329
Hospital Charge Code	38472602
Hospital Revenue Code	301
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.80
Rate for Payer: Aetna Medicare Advantage	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.63
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges