Heights University Hospital

All Charges

Charge

Type

Setting

Price

SEMEN ANALYSIS, PRESENCE

Facility

$85.00

Service Code	HCPCS 89321
Hospital Charge Code	38473034
Hospital Revenue Code	309
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

SEMEN ANALYSIS PRESENCE MOTILT

Facility

$24.00

Service Code	HCPCS 89300
Hospital Charge Code	38477021
Hospital Revenue Code	300
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.88
Rate for Payer: Aetna Medicare Advantage	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.05
Rate for Payer: Cigna Commercial	$9.84
Rate for Payer: Cigna Medicare Advantage	$4.92
Rate for Payer: Clover Medicare Advantage	$9.35
Rate for Payer: EmblemHealth Commercial	$29.52
Rate for Payer: Humana Medicare Advantage	$10.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.84
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.43
Rate for Payer: Wellcare Medicare Advantage	$9.84

SEMEN ANALYSIS PRESENCE MOTILT

Facility

$24.00

Service Code	HCPCS 89300
Hospital Charge Code	38477021
Hospital Revenue Code	300
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

SEMEN ANALYSIS-VOLUM/CNT/MOT

Facility

$109.79

Service Code	HCPCS 89322
Hospital Charge Code	38477131
Hospital Revenue Code	300
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: Aetna Medicare Advantage	$15.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.79
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: Cigna Medicare Advantage	$7.75
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.50
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.47
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.43
Rate for Payer: Wellcare Medicare Advantage	$15.50

SEMEN ANALYSIS-VOLUM/CNT/MOT

Facility

$109.79

Service Code	HCPCS 89322
Hospital Charge Code	38477131
Hospital Revenue Code	300
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$16.47
Rate for Payer: Qualcare PPO/HMO/WC	$16.47

SEMITENDINOSIS GRAFT FROZEN

Facility

$9,750.00

Hospital Charge Code	270678186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

SEMITENDINOSIS GRAFT FROZEN

Facility

$9,750.00

Hospital Charge Code	270678186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$2,925.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

SEMITENDINOSUS GRAFT W/GRACIL

Facility

$8,615.00

Hospital Charge Code	270656958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,292.25
Max. Negotiated Rate	$4,307.50
Rate for Payer: Aetna Commercial	$2,584.50
Rate for Payer: Aetna Medicare Advantage	$2,584.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,196.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,196.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,196.82
Rate for Payer: Cigna Commercial	$4,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,084.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,292.25

SEMITENDINOSUS GRAFT W/GRACIL

Facility

$8,615.00

Hospital Charge Code	270656958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,292.25
Max. Negotiated Rate	$2,084.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,084.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,292.25

SEMITENDINOSUS W/GRACELIS

Facility

$8,565.00

Service Code	HCPCS C1762
Hospital Charge Code	270671214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$2,072.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SEMITENDINOSUS W/GRACELIS

Facility

$8,565.00

Service Code	HCPCS C1762
Hospital Charge Code	270671214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$4,282.50
Rate for Payer: Aetna Commercial	$2,569.50
Rate for Payer: Aetna Medicare Advantage	$2,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,184.07
Rate for Payer: Cigna Commercial	$4,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SEM PRESS FIR STEM SZ 12

Facility

$7,803.00

Hospital Charge Code	270689493
Hospital Revenue Code	272
Min. Negotiated Rate	$1,170.45
Max. Negotiated Rate	$1,170.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.45

SEM PRESS FIR STEM SZ 12

Facility

$7,803.00

Hospital Charge Code	270689493
Hospital Revenue Code	272
Min. Negotiated Rate	$1,014.39
Max. Negotiated Rate	$3,901.50
Rate for Payer: Aetna Commercial	$2,340.90
Rate for Payer: Aetna Medicare Advantage	$2,340.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.77
Rate for Payer: Cigna Commercial	$3,901.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,014.39
Rate for Payer: Oxford Commercial	$3,901.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.45
Rate for Payer: UnitedHealthcare Commercial	$3,901.50

SENNA 8.6 MG TAB

Facility

$4.00

Service Code	NDC 67618030050
Hospital Charge Code	60628702
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SENNA 8.6 MG TAB

Facility

$4.00

Service Code	NDC 67618030050
Hospital Charge Code	60628702
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

SENNA 8.8 MG/5 ML SYRUP

Facility

$4.00

Service Code	NDC 59390012541
Hospital Charge Code	60629038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SENNA 8.8 MG/5 ML SYRUP

Facility

$4.00

Service Code	NDC 59390012541
Hospital Charge Code	60629038
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

SENNA CONCENTR 218MG/5ML SYRUP

Facility

$62.10

Hospital Charge Code	6009922
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

SENNA CONCENTR 218MG/5ML SYRUP

Facility

$62.10

Hospital Charge Code	6009922
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

SENNA CONCENTRATE 56GM GRANULE

Facility

$62.10

Hospital Charge Code	6009914
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

SENNA CONCENTRATE 56GM GRANULE

Facility

$62.10

Hospital Charge Code	6009914
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

SENNA TAB 374MG

Facility

$3.85

Hospital Charge Code	60628703
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

SENNA TAB 374MG

Facility

$3.85

Hospital Charge Code	60628703
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

SENOKOT SUPPOSITORY

Facility

$3.00

Hospital Charge Code	60634528
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SENOKOT SUPPOSITORY

Facility

$3.00

Hospital Charge Code	60634528
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

Know your out-of-pocket cost for care.

All Charges