Heights University Hospital

All Charges

Charge

Type

Setting

Price

SAMPLE PORT HME SMALL

Facility

$5.35

Hospital Charge Code	270637629
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SAMPLING PORT*****

Facility

$9.00

Hospital Charge Code	8002644
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

SAMPLING PORT*****

Facility

$9.00

Hospital Charge Code	8002644
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

SAMURAI BLADE FULL RADIUS

Facility

$1,211.00

Hospital Charge Code	270680361
Hospital Revenue Code	272
Min. Negotiated Rate	$181.65
Max. Negotiated Rate	$181.65
Rate for Payer: Qualcare PPO/HMO/WC	$181.65

SAMURAI BLADE FULL RADIUS

Facility

$1,211.00

Hospital Charge Code	270680361
Hospital Revenue Code	272
Min. Negotiated Rate	$157.43
Max. Negotiated Rate	$605.50
Rate for Payer: Aetna Commercial	$363.30
Rate for Payer: Aetna Medicare Advantage	$363.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.81
Rate for Payer: Cigna Commercial	$605.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.43
Rate for Payer: Oxford Commercial	$605.50
Rate for Payer: Qualcare PPO/HMO/WC	$181.65
Rate for Payer: UnitedHealthcare Commercial	$605.50

SANDIMMUNE/100MG/1ML

Facility

$1,478.00

Hospital Charge Code	60633856
Hospital Revenue Code	250
Min. Negotiated Rate	$221.70
Max. Negotiated Rate	$221.70
Rate for Payer: Qualcare PPO/HMO/WC	$221.70

SANDIMMUNE/100MG/1ML

Facility

$1,478.00

Hospital Charge Code	60633856
Hospital Revenue Code	250
Min. Negotiated Rate	$192.14
Max. Negotiated Rate	$739.00
Rate for Payer: Aetna Commercial	$443.40
Rate for Payer: Aetna Medicare Advantage	$443.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.89
Rate for Payer: Cigna Commercial	$739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.14
Rate for Payer: Oxford Commercial	$739.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.70
Rate for Payer: UnitedHealthcare Commercial	$739.00

SANDIMMUNE CAPS 100MG

Facility

$26.00

Hospital Charge Code	60635002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

SANDIMMUNE CAPS 100MG

Facility

$26.00

Hospital Charge Code	60635002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

SANDOSTATIN 5000MCG MDV

Facility

$4,214.00

Hospital Charge Code	60635516
Hospital Revenue Code	636
Min. Negotiated Rate	$632.10
Max. Negotiated Rate	$2,107.00
Rate for Payer: Aetna Commercial	$1,264.20
Rate for Payer: Aetna Medicare Advantage	$1,264.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,074.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,074.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,074.57
Rate for Payer: Cigna Commercial	$2,107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.79
Rate for Payer: Qualcare PPO/HMO/WC	$632.10

SANDOSTATIN 5000MCG MDV

Facility

$4,214.00

Hospital Charge Code	60635516
Hospital Revenue Code	636
Min. Negotiated Rate	$632.10
Max. Negotiated Rate	$1,019.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.79
Rate for Payer: Qualcare PPO/HMO/WC	$632.10

SANSERT/1MG/TAB

Facility

$3.00

Hospital Charge Code	60634395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SANSERT/1MG/TAB

Facility

$3.00

Hospital Charge Code	60634395
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

SANTYL OINT 30 GMS

Facility

$140.00

Hospital Charge Code	60635223
Hospital Revenue Code	250
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

SANTYL OINT 30 GMS

Facility

$140.00

Hospital Charge Code	60635223
Hospital Revenue Code	250
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$70.00

SAPHENOUS VEIN #VTS03151101B

Facility

$24,000.00

Hospital Charge Code	270656768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,600.00
Max. Negotiated Rate	$5,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00

SAPHENOUS VEIN #VTS03151101B

Facility

$24,000.00

Hospital Charge Code	270656768
Hospital Revenue Code	278
Min. Negotiated Rate	$3,600.00
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$7,200.00
Rate for Payer: Aetna Medicare Advantage	$7,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,120.00
Rate for Payer: Cigna Commercial	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00

SAQUINAVIR MESYLATE 200 MG CAP

Facility

$30.62

Service Code	NDC 4024515
Hospital Charge Code	60629027
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$9.19
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$15.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.98
Rate for Payer: Oxford Commercial	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$15.31

SAQUINAVIR MESYLATE 200 MG CAP

Facility

$30.62

Service Code	NDC 4024515
Hospital Charge Code	60629027
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

SARAN ROLL *************

Facility

$168.00

Hospital Charge Code	8001646
Hospital Revenue Code	279
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$50.40
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$84.00

SARAN ROLL *************

Facility

$168.00

Hospital Charge Code	8001646
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

SARGRAMOSTIM INJ 250MCG

Facility

$485.80

Hospital Charge Code	6016299
Hospital Revenue Code	636
Min. Negotiated Rate	$72.87
Max. Negotiated Rate	$242.90
Rate for Payer: Aetna Commercial	$145.74
Rate for Payer: Aetna Medicare Advantage	$145.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.88
Rate for Payer: Cigna Commercial	$242.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$72.87

SARGRAMOSTIM INJ 250MCG

Facility

$485.80

Hospital Charge Code	6016299
Hospital Revenue Code	636
Min. Negotiated Rate	$72.87
Max. Negotiated Rate	$117.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$72.87

SARGRAMOSTIM INJ 500MCG

Facility

$910.75

Hospital Charge Code	6016281
Hospital Revenue Code	636
Min. Negotiated Rate	$136.61
Max. Negotiated Rate	$220.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.40
Rate for Payer: Qualcare PPO/HMO/WC	$136.61

SARGRAMOSTIM INJ 500MCG

Facility

$910.75

Hospital Charge Code	6016281
Hospital Revenue Code	636
Min. Negotiated Rate	$136.61
Max. Negotiated Rate	$455.38
Rate for Payer: Aetna Commercial	$273.23
Rate for Payer: Aetna Medicare Advantage	$273.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.24
Rate for Payer: Cigna Commercial	$455.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.40
Rate for Payer: Qualcare PPO/HMO/WC	$136.61

Know your out-of-pocket cost for care.

All Charges