Heights University Hospital

All Charges

Charge

Type

Setting

Price

SEC LUM ANT CAGE MED H16 10DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	2703855
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SEC LUM ANT CAGE MEDIUM

Facility

$25,000.00

Hospital Charge Code	270702843
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SEC LUM ANT CAGE MEDIUM

Facility

$25,000.00

Hospital Charge Code	270702843
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SEC LUM ANT CAGE SM H14 10DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703792
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SEC LUM ANT CAGE SM H14 10DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703792
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SEC LUM ANT CAGE SM H16 15D

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703793
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SEC LUM ANT CAGE SM H16 15D

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703793
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECOBARBITAL CAP 100MG

Facility

$4.00

Hospital Charge Code	60627838
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SECOBARBITAL CAP 100MG

Facility

$4.00

Hospital Charge Code	60627838
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SECOBARBITAL INJ/100MG

Facility

$152.00

Hospital Charge Code	60634343
Hospital Revenue Code	250
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$76.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$76.00

SECOBARBITAL INJ/100MG

Facility

$152.00

Hospital Charge Code	60634343
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

SECONAL/100MG/CAP

Facility

$3.00

Hospital Charge Code	60634412
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

SECONAL/100MG/CAP

Facility

$3.00

Hospital Charge Code	60634412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SECOND CHANCE PROGRAM ADULT

Facility

$665.50

Service Code	HCPCS 99213
Hospital Charge Code	485099218
Hospital Revenue Code	919
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$199.65
Rate for Payer: Aetna Commercial	$199.65
Rate for Payer: Aetna Medicare Advantage	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.70
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.52
Rate for Payer: Qualcare PPO/HMO/WC	$99.83

SECOND CHANCE PROGRAM ADULT

Facility

$665.50

Service Code	HCPCS 99213
Hospital Charge Code	485099218
Hospital Revenue Code	919
Min. Negotiated Rate	$99.83
Max. Negotiated Rate	$99.83
Rate for Payer: Qualcare PPO/HMO/WC	$99.83

SECOND LEVEL CER DISKECTOMY AD

Facility

$6,238.00

Service Code	HCPCS 22858
Hospital Charge Code	1600000582
Hospital Revenue Code	360
Min. Negotiated Rate	$935.70
Max. Negotiated Rate	$935.70
Rate for Payer: Qualcare PPO/HMO/WC	$935.70

SECOND LEVEL CER DISKECTOMY AD

Facility

$6,238.00

Service Code	HCPCS 22858
Hospital Charge Code	1600000582
Hospital Revenue Code	360
Min. Negotiated Rate	$486.78
Max. Negotiated Rate	$1,871.40
Rate for Payer: Aetna Commercial	$1,871.40
Rate for Payer: Aetna Medicare Advantage	$1,871.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,590.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,590.69
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	$1,590.69
Rate for Payer: Cigna Commercial	$486.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$935.70
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

SECREFLO,16.MG

Facility

$5.00

Hospital Charge Code	60635462
Hospital Revenue Code	250
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

SECREFLO,16.MG

Facility

$5.00

Hospital Charge Code	60635462
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SECRETIN 16 MCG VIAL

Facility

$3,517.50

Service Code	HCPCS J2850
Hospital Charge Code	60628905
Hospital Revenue Code	636
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

SECRETIN 16 MCG VIAL

Facility

$3,517.50

Service Code	HCPCS J2850
Hospital Charge Code	60628905
Hospital Revenue Code	636
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$1,055.25
Rate for Payer: Aetna Commercial	$1,055.25
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

SECRETIN INJ 75CU

Facility

$871.05

Hospital Charge Code	6010581
Hospital Revenue Code	250
Min. Negotiated Rate	$113.24
Max. Negotiated Rate	$435.52
Rate for Payer: Aetna Commercial	$261.31
Rate for Payer: Aetna Medicare Advantage	$261.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.12
Rate for Payer: Cigna Commercial	$435.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.24
Rate for Payer: Oxford Commercial	$435.52
Rate for Payer: Qualcare PPO/HMO/WC	$130.66
Rate for Payer: UnitedHealthcare Commercial	$435.52

SECRETIN INJ 75CU

Facility

$871.05

Hospital Charge Code	6010581
Hospital Revenue Code	250
Min. Negotiated Rate	$130.66
Max. Negotiated Rate	$130.66
Rate for Payer: Qualcare PPO/HMO/WC	$130.66

SECTRAL/200MG/CAP

Facility

$5.00

Hospital Charge Code	60633857
Hospital Revenue Code	250
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

SECTRAL/200MG/CAP

Facility

$5.00

Hospital Charge Code	60633857
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

Know your out-of-pocket cost for care.

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