Heights University Hospital

All Charges

Charge

Type

Setting

Price

SBCL PHLEBOTOMY SERVICE

Facility

$25.00

Hospital Charge Code	38474114
Hospital Revenue Code	301
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

S/B LESION

Facility

$1,083.25

Service Code	HCPCS 11057
Hospital Charge Code	87502565
Hospital Revenue Code	761
Min. Negotiated Rate	$162.49
Max. Negotiated Rate	$162.49
Rate for Payer: Qualcare PPO/HMO/WC	$162.49

S/B LESION

Facility

$1,083.25

Service Code	HCPCS 11057
Hospital Charge Code	87502565
Hospital Revenue Code	761
Min. Negotiated Rate	$45.25
Max. Negotiated Rate	$541.62
Rate for Payer: Aetna Commercial	$324.98
Rate for Payer: Aetna Medicare Advantage	$324.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.23
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.82
Rate for Payer: Oxford Commercial	$541.62
Rate for Payer: Qualcare PPO/HMO/WC	$162.49
Rate for Payer: UnitedHealthcare Commercial	$541.62

SBRT DELIVERY

Facility

$9,462.75

Service Code	HCPCS 77373
Hospital Charge Code	85000675
Hospital Revenue Code	333
Min. Negotiated Rate	$1,419.41
Max. Negotiated Rate	$1,419.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,419.41

SBRT DELIVERY

Facility

$9,462.75

Service Code	HCPCS 77373
Hospital Charge Code	85000675
Hospital Revenue Code	333
Min. Negotiated Rate	$1,009.00
Max. Negotiated Rate	$4,258.06
Rate for Payer: Aetna Commercial	$2,838.82
Rate for Payer: Aetna Medicare Advantage	$2,838.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,413.00
Rate for Payer: Cigna Commercial	$4,258.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,230.16
Rate for Payer: Oxford Commercial	$1,009.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,419.41
Rate for Payer: UnitedHealthcare Commercial	$1,146.00

SBRT MANAGEMENT

Facility

$3,300.35

Service Code	HCPCS 77435
Hospital Charge Code	85000795
Hospital Revenue Code	333
Min. Negotiated Rate	$495.05
Max. Negotiated Rate	$495.05
Rate for Payer: Qualcare PPO/HMO/WC	$495.05

SBRT MANAGEMENT

Facility

$3,300.35

Service Code	HCPCS 77435
Hospital Charge Code	85000795
Hospital Revenue Code	333
Min. Negotiated Rate	$429.05
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$990.11
Rate for Payer: Aetna Medicare Advantage	$990.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.59
Rate for Payer: Cigna Commercial	$703.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.05
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.05
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

SCAFFOLD CELL BN MATRIX 1CC

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SCAFFOLD CELL BN MATRIX 1CC

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SCALE PEDIATRIC/INFANT 1G

Facility

$9,975.00

Hospital Charge Code	270658989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

SCALE PEDIATRIC/INFANT 1G

Facility

$9,975.00

Hospital Charge Code	270658989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

SCALLOP IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003A
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

SCALLOP IGE

Facility

$390.00

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

SCALP DISPOSABLE CLIP APPLIER

Facility

$2,750.00

Hospital Charge Code	270665367
Hospital Revenue Code	270
Min. Negotiated Rate	$357.50
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$825.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$357.50
Rate for Payer: Oxford Commercial	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$1,375.00

SCALP DISPOSABLE CLIP APPLIER

Facility

$2,750.00

Hospital Charge Code	270665367
Hospital Revenue Code	270
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

SCALPEL BLADE #10 STER DISP

Facility

$5.86

Hospital Charge Code	270650075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

SCALPEL BLADE #10 STER DISP

Facility

$5.86

Hospital Charge Code	270650075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.76
Rate for Payer: Oxford Commercial	$2.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$2.93

SCALPEL BLADE #11 STER DISP

Facility

$5.29

Hospital Charge Code	270650095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SCALPEL BLADE #11 STER DISP

Facility

$5.29

Hospital Charge Code	270650095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$1.59
Rate for Payer: Aetna Medicare Advantage	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.69
Rate for Payer: Oxford Commercial	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$2.65

SCALPEL BLADE #15 STER DISP

Facility

$5.86

Hospital Charge Code	270650074
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.76
Rate for Payer: Oxford Commercial	$2.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$2.93

SCALPEL BLADE #15 STER DISP

Facility

$5.86

Hospital Charge Code	270650074
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

SCALPEL DISP

Facility

$5.00

Hospital Charge Code	8001653
Hospital Revenue Code	279
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

SCALPEL DISP

Facility

$5.00

Hospital Charge Code	8001653
Hospital Revenue Code	279
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SCALPEL ETH HARMONIC HP052

Facility

$9,220.70

Hospital Charge Code	270619777
Hospital Revenue Code	272
Min. Negotiated Rate	$1,383.11
Max. Negotiated Rate	$1,383.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,383.11

SCALPEL ETH HARMONIC HP052

Facility

$9,220.70

Hospital Charge Code	270619777
Hospital Revenue Code	272
Min. Negotiated Rate	$1,198.69
Max. Negotiated Rate	$4,610.35
Rate for Payer: Aetna Commercial	$2,766.21
Rate for Payer: Aetna Medicare Advantage	$2,766.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,351.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,351.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,351.28
Rate for Payer: Cigna Commercial	$4,610.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,198.69
Rate for Payer: Oxford Commercial	$4,610.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,383.11
Rate for Payer: UnitedHealthcare Commercial	$4,610.35

Know your out-of-pocket cost for care.

All Charges