Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCORPION MINI KIT IMPL SYSTEM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270661232
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$1,642.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

SCORPION MINI KIT IMPL SYSTEM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270661232
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

SCORPION NEEDLE KNEE

Facility

$975.00

Hospital Charge Code	270682511
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.75
Rate for Payer: Oxford Commercial	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$487.50

SCORPION NEEDLE KNEE

Facility

$975.00

Hospital Charge Code	270682511
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SCOTCHCAST 2 SPLINTING SYSTEM

Facility

$92.00

Hospital Charge Code	270332283
Hospital Revenue Code	272
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$46.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$46.00

SCOTCHCAST 2 SPLINTING SYSTEM

Facility

$92.00

Hospital Charge Code	270332283
Hospital Revenue Code	272
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

SCOTCH CAST-2 TAPE 2'

Facility

$25.00

Hospital Charge Code	270332239
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

SCOTCH CAST-2 TAPE 2'

Facility

$25.00

Hospital Charge Code	270332239
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

SCOTCH CAST-2 TAPE 3

Facility

$30.00

Hospital Charge Code	270332244
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

SCOTCH CAST-2 TAPE 3

Facility

$30.00

Hospital Charge Code	270332244
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SCOTCH CAST-2 TAPE 4'

Facility

$39.00

Hospital Charge Code	270332246
Hospital Revenue Code	272
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$19.50

SCOTCH CAST-2 TAPE 4'

Facility

$39.00

Hospital Charge Code	270332246
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

SCOTCH CAST-2 TAPE 5

Facility

$48.00

Hospital Charge Code	270332248
Hospital Revenue Code	272
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

SCOTCH CAST-2 TAPE 5

Facility

$48.00

Hospital Charge Code	270332248
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SCOTT-TUSSIN 30 ML DM

Facility

$3.00

Hospital Charge Code	60635303
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SCOTT-TUSSIN 30 ML DM

Facility

$3.00

Hospital Charge Code	60635303
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

SCOT-TUSSIN EXP S/A FREE

Facility

$3.00

Hospital Charge Code	60635273
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

SCOT-TUSSIN EXP S/A FREE

Facility

$3.00

Hospital Charge Code	60635273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SCPCOMPFTANKLKT5CCDEL11GX120MM

Facility

$23,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270696479
Hospital Revenue Code	278
Min. Negotiated Rate	$3,495.00
Max. Negotiated Rate	$11,650.00
Rate for Payer: Aetna Commercial	$6,990.00
Rate for Payer: Aetna Medicare Advantage	$6,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,941.50
Rate for Payer: Cigna Commercial	$11,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,638.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00

SCPCOMPFTANKLKT5CCDEL11GX120MM

Facility

$23,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270696479
Hospital Revenue Code	278
Min. Negotiated Rate	$3,495.00
Max. Negotiated Rate	$5,638.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,638.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00

SCR BON CORT 150x50HAA60-15050

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270635000
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$398.75
Rate for Payer: Aetna Commercial	$239.25
Rate for Payer: Aetna Medicare Advantage	$239.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.36
Rate for Payer: Cigna Commercial	$398.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

SCR BON CORT 150x50HAA60-15050

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270635000
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

SCRE CAN 3Mx14M S.S S30.14S.11

Facility

$575.00

Hospital Charge Code	270639856
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

SCRE CAN 3Mx14M S.S S30.14S.11

Facility

$575.00

Hospital Charge Code	270639856
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

Know your out-of-pocket cost for care.

All Charges