Heights University Hospital

All Charges

Charge

Type

Setting

Price

SARGRAMOSTIM INJ 50MCG

Facility

$95.40

Hospital Charge Code	6017123
Hospital Revenue Code	636
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.09
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

SARGRAMOSTIM INJ 50MCG

Facility

$95.40

Hospital Charge Code	6017123
Hospital Revenue Code	636
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$23.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.09
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

SARGRAMOSTIM IVPB 500MG/ML

Facility

$1,728.00

Hospital Charge Code	60628954
Hospital Revenue Code	636
Min. Negotiated Rate	$259.20
Max. Negotiated Rate	$864.00
Rate for Payer: Aetna Commercial	$518.40
Rate for Payer: Aetna Medicare Advantage	$518.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$440.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$440.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$440.64
Rate for Payer: Cigna Commercial	$864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.18
Rate for Payer: Qualcare PPO/HMO/WC	$259.20

SARGRAMOSTIM IVPB 500MG/ML

Facility

$1,728.00

Hospital Charge Code	60628954
Hospital Revenue Code	636
Min. Negotiated Rate	$259.20
Max. Negotiated Rate	$418.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.18
Rate for Payer: Qualcare PPO/HMO/WC	$259.20

SAROFLOXAIN INJ 250MG/50ML

Facility

$136.35

Hospital Charge Code	6017917
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$40.91
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.73
Rate for Payer: Oxford Commercial	$68.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$68.17

SAROFLOXAIN INJ 250MG/50ML

Facility

$136.35

Hospital Charge Code	6017917
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

SARS-COV-2 COVID-19 ANTIBODY

Facility

$387.00

Service Code	HCPCS 86769
Hospital Charge Code	401386769
Hospital Revenue Code	302
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$154.36
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.36
Rate for Payer: Cigna Commercial	$42.13
Rate for Payer: Cigna Medicare Advantage	$21.07
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.66
Rate for Payer: Wellcare Medicare Advantage	$42.13

SARS-COV-2 COVID-19 ANTIBODY

Facility

$387.00

Service Code	HCPCS 86769
Hospital Charge Code	401386769
Hospital Revenue Code	302
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

SARSCO V2 &INFO AB RSV AMP PRB

Facility

$1,400.00

Service Code	HCPCS 87637
Hospital Charge Code	4013878044
Hospital Revenue Code	306
Min. Negotiated Rate	$71.31
Max. Negotiated Rate	$522.60
Rate for Payer: Aetna Commercial	$462.12
Rate for Payer: Aetna Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.60
Rate for Payer: Cigna Commercial	$142.63
Rate for Payer: Cigna Medicare Advantage	$71.31
Rate for Payer: Clover Medicare Advantage	$135.50
Rate for Payer: EmblemHealth Commercial	$427.89
Rate for Payer: Humana Medicare Advantage	$146.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$142.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$151.19
Rate for Payer: Wellcare Medicare Advantage	$142.63

SARSCO V2 &INFO AB RSV AMP PRB

Facility

$1,400.00

Service Code	HCPCS 87637
Hospital Charge Code	4013878044
Hospital Revenue Code	306
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

SARSCOV2NUCLEOCAPIGMSPIKEQL

Facility

$210.65

Service Code	HCPCS 86769
Hospital Charge Code	401386769D
Hospital Revenue Code	302
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$154.36
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.36
Rate for Payer: Cigna Commercial	$42.13
Rate for Payer: Cigna Medicare Advantage	$21.07
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.66
Rate for Payer: Wellcare Medicare Advantage	$42.13

SARSCOV2NUCLEOCAPIGMSPIKEQL

Facility

$210.65

Service Code	HCPCS 86769
Hospital Charge Code	401386769D
Hospital Revenue Code	302
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.60

SARS-COV-2 RNA PCR COVID19 QUE

Facility

$345.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$147.80
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

SARS-COV-2 RNA PCR COVID19 QUE

Facility

$345.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798
Hospital Revenue Code	306
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

SATURATE MIXING SYSTEM

Facility

$126.83

Hospital Charge Code	270670677
Hospital Revenue Code	272
Min. Negotiated Rate	$16.49
Max. Negotiated Rate	$63.41
Rate for Payer: Aetna Commercial	$38.05
Rate for Payer: Aetna Medicare Advantage	$38.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.34
Rate for Payer: Cigna Commercial	$63.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.49
Rate for Payer: Oxford Commercial	$63.41
Rate for Payer: Qualcare PPO/HMO/WC	$19.02
Rate for Payer: UnitedHealthcare Commercial	$63.41

SATURATE MIXING SYSTEM

Facility

$126.83

Hospital Charge Code	270670677
Hospital Revenue Code	272
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$19.02
Rate for Payer: Qualcare PPO/HMO/WC	$19.02

SAVE A TOOTH****

Facility

$61.00

Hospital Charge Code	8007392
Hospital Revenue Code	272
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

SAVE A TOOTH****

Facility

$61.00

Hospital Charge Code	8007392
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

SAVE A TOOTH******

Facility

$61.00

Hospital Charge Code	8004392
Hospital Revenue Code	272
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

SAVE A TOOTH******

Facility

$61.00

Hospital Charge Code	8004392
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

SAVER CELL AUTOTRAN

Facility

$2,363.25

Hospital Charge Code	270601082
Hospital Revenue Code	272
Min. Negotiated Rate	$307.22
Max. Negotiated Rate	$1,181.62
Rate for Payer: Aetna Commercial	$708.98
Rate for Payer: Aetna Medicare Advantage	$708.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$602.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$602.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$602.63
Rate for Payer: Cigna Commercial	$1,181.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.22
Rate for Payer: Oxford Commercial	$1,181.62
Rate for Payer: Qualcare PPO/HMO/WC	$354.49
Rate for Payer: UnitedHealthcare Commercial	$1,181.62

SAVER CELL AUTOTRAN

Facility

$2,363.25

Hospital Charge Code	270601082
Hospital Revenue Code	272
Min. Negotiated Rate	$354.49
Max. Negotiated Rate	$354.49
Rate for Payer: Qualcare PPO/HMO/WC	$354.49

SAVER CELL AUTOTRANS

Facility

$2,874.45

Hospital Charge Code	270601081
Hospital Revenue Code	272
Min. Negotiated Rate	$373.68
Max. Negotiated Rate	$1,437.22
Rate for Payer: Aetna Commercial	$862.34
Rate for Payer: Aetna Medicare Advantage	$862.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.98
Rate for Payer: Cigna Commercial	$1,437.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.68
Rate for Payer: Oxford Commercial	$1,437.22
Rate for Payer: Qualcare PPO/HMO/WC	$431.17
Rate for Payer: UnitedHealthcare Commercial	$1,437.22

SAVER CELL AUTOTRANS

Facility

$2,874.45

Hospital Charge Code	270601081
Hospital Revenue Code	272
Min. Negotiated Rate	$431.17
Max. Negotiated Rate	$431.17
Rate for Payer: Qualcare PPO/HMO/WC	$431.17

SAVORY DILATATION***

Facility

$237.60

Hospital Charge Code	2300614
Hospital Revenue Code	759
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$71.28
Rate for Payer: Aetna Medicare Advantage	$71.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.59
Rate for Payer: Cigna Commercial	$118.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.64

Know your out-of-pocket cost for care.

All Charges