Heights University Hospital

All Charges

Charge

Type

Setting

Price

SALMONELLA AB V

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149E
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

SALMONELLA AB V

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMON IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035138
Hospital Revenue Code	305
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.13
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: Cigna Medicare Advantage	$2.61
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.22

SALMON IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMON IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003F
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.13
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: Cigna Medicare Advantage	$2.61
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.22

SALMON IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035138
Hospital Revenue Code	305
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

SALPINGECTOMY COMPL/PART UL/BL

Facility

$8,767.70

Service Code	HCPCS 58700
Hospital Charge Code	16001010
Hospital Revenue Code	360
Min. Negotiated Rate	$1,315.15
Max. Negotiated Rate	$1,315.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,315.15

SALPINGECTOMY COMPL/PART UL/BL

Facility

$8,767.70

Service Code	HCPCS 58700
Hospital Charge Code	16001010
Hospital Revenue Code	360
Min. Negotiated Rate	$798.78
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$2,630.31
Rate for Payer: Aetna Medicare Advantage	$2,630.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,235.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,235.76
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	$2,235.76
Rate for Payer: Cigna Commercial	$798.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,139.80
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,315.15
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

SALPINGO-OOPHOR COML/PART UL/B

Facility

$9,154.20

Service Code	HCPCS 58720
Hospital Charge Code	16000766
Hospital Revenue Code	360
Min. Negotiated Rate	$1,373.13
Max. Negotiated Rate	$1,373.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.13

SALPINGO-OOPHOR COML/PART UL/B

Facility

$9,154.20

Service Code	HCPCS 58720
Hospital Charge Code	16000766
Hospital Revenue Code	360
Min. Negotiated Rate	$764.27
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$2,746.26
Rate for Payer: Aetna Medicare Advantage	$2,746.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,334.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,334.32
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	$2,334.32
Rate for Payer: Cigna Commercial	$764.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,190.05
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.13
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

SALSALATE TAB 500MG

Facility

$4.50

Hospital Charge Code	60627696
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

SALSALATE TAB 500MG

Facility

$4.50

Hospital Charge Code	60627696
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

SALSALATE TAB 750MG

Facility

$3.20

Hospital Charge Code	60628701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

SALSALATE TAB 750MG

Facility

$3.20

Hospital Charge Code	60628701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

SAL-TROPINE TAB

Facility

$3.00

Hospital Charge Code	60635139
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

SAL-TROPINE TAB

Facility

$3.00

Hospital Charge Code	60635139
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SALUTENSIN 50/0.125/TAB

Facility

$6.00

Hospital Charge Code	60633855
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

SALUTENSIN 50/0.125/TAB

Facility

$6.00

Hospital Charge Code	60633855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SAME DAY SURG EA ADD 30 MIN

Facility

$2,548.00

Hospital Charge Code	100042
Hospital Revenue Code	360
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$382.20
Rate for Payer: Qualcare PPO/HMO/WC	$382.20

SAME DAY SURG EA ADD 30 MIN

Facility

$2,548.00

Hospital Charge Code	100042
Hospital Revenue Code	360
Min. Negotiated Rate	$331.24
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$764.40
Rate for Payer: Aetna Medicare Advantage	$764.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$649.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$649.74
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	$649.74
Rate for Payer: Cigna Commercial	$1,274.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.24
Rate for Payer: Qualcare PPO/HMO/WC	$382.20

SAME DAY SURGERY ROOM

Facility

$4,950.47

Hospital Charge Code	100040
Hospital Revenue Code	360
Min. Negotiated Rate	$742.57
Max. Negotiated Rate	$742.57
Rate for Payer: Qualcare PPO/HMO/WC	$742.57

SAME DAY SURGERY ROOM

Facility

$4,950.47

Hospital Charge Code	100040
Hospital Revenue Code	360
Min. Negotiated Rate	$643.56
Max. Negotiated Rate	$2,475.24
Rate for Payer: Aetna Commercial	$1,485.14
Rate for Payer: Aetna Medicare Advantage	$1,485.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.37
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	$1,262.37
Rate for Payer: Cigna Commercial	$2,475.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.56
Rate for Payer: Qualcare PPO/HMO/WC	$742.57

SAMPLE LINE 2.3 M GAS ADULT

Facility

$45.74

Hospital Charge Code	270683949
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

SAMPLE LINE 2.3 M GAS ADULT

Facility

$45.74

Hospital Charge Code	270683949
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$22.87
Rate for Payer: Aetna Commercial	$13.72
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.66
Rate for Payer: Cigna Commercial	$22.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Oxford Commercial	$22.87
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$22.87

SAMPLE PORT HME SMALL

Facility

$5.35

Hospital Charge Code	270637629
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.67

Know your out-of-pocket cost for care.

All Charges