Heights University Hospital

All Charges

Charge

Type

Setting

Price

SEVOFLURANE - INH LIQ

Facility

$1,511.52

Service Code	NDC 74445651
Hospital Charge Code	60629265
Hospital Revenue Code	250
Min. Negotiated Rate	$226.73
Max. Negotiated Rate	$226.73
Rate for Payer: Qualcare PPO/HMO/WC	$226.73

SEVOFLURANE - INH LIQ

Facility

$1,511.52

Service Code	NDC 74445651
Hospital Charge Code	60629265
Hospital Revenue Code	250
Min. Negotiated Rate	$196.50
Max. Negotiated Rate	$755.76
Rate for Payer: Aetna Commercial	$453.46
Rate for Payer: Aetna Medicare Advantage	$453.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.44
Rate for Payer: Cigna Commercial	$755.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.50
Rate for Payer: Oxford Commercial	$755.76
Rate for Payer: Qualcare PPO/HMO/WC	$226.73
Rate for Payer: UnitedHealthcare Commercial	$755.76

SEX HORMONE BIND GLOBULN#B04**

Facility

$21.00

Hospital Charge Code	3010691
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

SEX HORMONE BIND GLOBULN#B04**

Facility

$21.00

Hospital Charge Code	3010691
Hospital Revenue Code	301
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEX HORMONE BINDING GLOBU

Facility

$390.00

Service Code	HCPCS 84270
Hospital Charge Code	39900132
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEX HORMONE BINDING GLOBU

Facility

$390.00

Service Code	HCPCS 84270
Hospital Charge Code	39900132
Hospital Revenue Code	301
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.41
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.62
Rate for Payer: Cigna Commercial	$21.73
Rate for Payer: Cigna Medicare Advantage	$10.87
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
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	$21.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.03
Rate for Payer: Wellcare Medicare Advantage	$21.73

SEX HORMONE BINDING GLOBULIN

Facility

$153.90

Service Code	HCPCS 84270
Hospital Charge Code	38477170
Hospital Revenue Code	301
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.41
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.62
Rate for Payer: Cigna Commercial	$21.73
Rate for Payer: Cigna Medicare Advantage	$10.87
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.03
Rate for Payer: Wellcare Medicare Advantage	$21.73

SEX HORMONE BINDING GLOBULIN

Facility

$153.90

Service Code	HCPCS 84270
Hospital Charge Code	38477170
Hospital Revenue Code	301
Min. Negotiated Rate	$23.09
Max. Negotiated Rate	$23.09
Rate for Payer: Qualcare PPO/HMO/WC	$23.09

SEX HORMONE BINDING GLOBULIN

Facility

$179.25

Service Code	HCPCS 84270
Hospital Charge Code	3000692
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

SEX HORMONE BINDING GLOBULIN

Facility

$179.25

Service Code	HCPCS 84270
Hospital Charge Code	3000692
Hospital Revenue Code	301
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.41
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.62
Rate for Payer: Cigna Commercial	$21.73
Rate for Payer: Cigna Medicare Advantage	$10.87
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.03
Rate for Payer: Wellcare Medicare Advantage	$21.73

SEXUAL ASSAULT KIT

Facility

$118.00

Hospital Charge Code	60635642
Hospital Revenue Code	250
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$35.40
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$59.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$59.00

SEXUAL ASSAULT KIT

Facility

$118.00

Hospital Charge Code	60635642
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

SFT NON BRDED MKLSSON 5FRX80CM

Facility

$510.00

Hospital Charge Code	270663267
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

SFT NON BRDED MKLSSON 5FRX80CM

Facility

$510.00

Hospital Charge Code	270663267
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

SFT TISS BX - NECK/THORAX

Facility

$13,615.50

Service Code	HCPCS 21550
Hospital Charge Code	16000798
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

SFT TISS BX - NECK/THORAX

Facility

$13,615.50

Service Code	HCPCS 21550
Hospital Charge Code	16000798
Hospital Revenue Code	360
Min. Negotiated Rate	$1,770.02
Max. Negotiated Rate	$4,084.65
Rate for Payer: Aetna Commercial	$4,084.65
Rate for Payer: Aetna Medicare Advantage	$4,084.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,471.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,471.95
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	$3,471.95
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

SGL NBI BRACHIAL PLEXUS

Facility

$4,204.50

Service Code	HCPCS 64415
Hospital Charge Code	16000237
Hospital Revenue Code	360
Min. Negotiated Rate	$546.59
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,261.35
Rate for Payer: Aetna Medicare Advantage	$1,261.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,072.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,072.15
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	$1,072.15
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.59
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.67
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

SGL NBI BRACHIAL PLEXUS

Facility

$4,204.50

Service Code	HCPCS 64415
Hospital Charge Code	16000237
Hospital Revenue Code	360
Min. Negotiated Rate	$630.67
Max. Negotiated Rate	$630.67
Rate for Payer: Qualcare PPO/HMO/WC	$630.67

SGOT (AST)

Facility

$47.25

Service Code	HCPCS 84450
Hospital Charge Code	8200329RS
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

SGOT (AST)

Facility

$47.25

Service Code	HCPCS 84450
Hospital Charge Code	8200329RS
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

SGPT (ALT)

Facility

$7.44

Service Code	HCPCS 84460CF
Hospital Charge Code	8200330RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SGPT (ALT)

Facility

$7.44

Service Code	HCPCS 84460CF
Hospital Charge Code	8200330RS
Hospital Revenue Code	301
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$114.00

SHAFT BIXCUT MOD TRINKLE

Facility

$2,375.00

Hospital Charge Code	270670465
Hospital Revenue Code	272
Min. Negotiated Rate	$308.75
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$1,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$1,187.50

SHAFT BIXCUT MOD TRINKLE

Facility

$2,375.00

Hospital Charge Code	270670465
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

SHAFT FIBULA

Facility

$3,250.00

Hospital Charge Code	270668464
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

Know your out-of-pocket cost for care.

All Charges