Heights University Hospital

All Charges

Charge

Type

Setting

Price

SINGLE USE LIGATING DEVICE

Facility

$867.00

Hospital Charge Code	270325383
Hospital Revenue Code	272
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

SINGLE USE LIGATING DEVICE

Facility

$867.00

Hospital Charge Code	270325383
Hospital Revenue Code	272
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.71
Rate for Payer: Oxford Commercial	$433.50
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Commercial	$433.50

SINGLE USE LIGATING DEVICE

Facility

$174.00

Hospital Charge Code	270325685
Hospital Revenue Code	272
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$87.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$87.00

SINGLE USE LIGATING DEVICE

Facility

$174.00

Hospital Charge Code	270325685
Hospital Revenue Code	272
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

SING/MULT TRIGGER PTS INJ 3 OR

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	5780025
Hospital Revenue Code	450
Min. Negotiated Rate	$31.13
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$327.30
Rate for Payer: Aetna Medicare Advantage	$327.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.20
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.83
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

SING/MULT TRIGGER PTS INJ 3 OR

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	5780025
Hospital Revenue Code	450
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

SINGULAIR 4MG CHEWTAB

Facility

$16.00

Hospital Charge Code	60635587
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$8.00

SINGULAIR 4MG CHEWTAB

Facility

$16.00

Hospital Charge Code	60635587
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SINGULAIR 5MG CHEW TAB

Facility

$37.92

Service Code	NDC 54028913
Hospital Charge Code	60635505
Hospital Revenue Code	250
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$18.96
Rate for Payer: Aetna Commercial	$11.38
Rate for Payer: Aetna Medicare Advantage	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.67
Rate for Payer: Cigna Commercial	$18.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.93
Rate for Payer: Oxford Commercial	$18.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.69
Rate for Payer: UnitedHealthcare Commercial	$18.96

SINGULAIR 5MG CHEW TAB

Facility

$37.92

Service Code	NDC 54028913
Hospital Charge Code	60635505
Hospital Revenue Code	250
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$5.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.69

SINGULAR 4MG ORAL GRANULE

Facility

$50.05

Service Code	NDC 6384130
Hospital Charge Code	60635657
Hospital Revenue Code	250
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$15.02
Rate for Payer: Aetna Medicare Advantage	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.76
Rate for Payer: Cigna Commercial	$25.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.51
Rate for Payer: Oxford Commercial	$25.02
Rate for Payer: Qualcare PPO/HMO/WC	$7.51
Rate for Payer: UnitedHealthcare Commercial	$25.02

SINGULAR 4MG ORAL GRANULE

Facility

$50.05

Service Code	NDC 6384130
Hospital Charge Code	60635657
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$7.51

SINU FOAM

Facility

$405.00

Hospital Charge Code	270686807
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

SINU FOAM

Facility

$405.00

Hospital Charge Code	270686807
Hospital Revenue Code	272
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$202.50
Rate for Payer: UnitedHealthcare Commercial	$202.50
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Oxford Commercial	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$74,808.09

Service Code	MSDRG 135
Min. Negotiated Rate	$23,680.30
Max. Negotiated Rate	$74,808.09
Rate for Payer: Aetna Commercial	$73,172.13
Rate for Payer: Aetna Medicare Advantage	$23,680.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73,052.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73,052.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,936.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73,052.55
Rate for Payer: Cigna Commercial	$45,521.22
Rate for Payer: Cigna Medicare Advantage	$24,936.03
Rate for Payer: Clover Medicare Advantage	$23,689.23
Rate for Payer: EmblemHealth Commercial	$74,808.09
Rate for Payer: Humana Medicare Advantage	$25,684.11
Rate for Payer: Oxford Commercial	$28,449.44
Rate for Payer: UnitedHealthcare Commercial	$32,292.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,936.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26,432.19
Rate for Payer: Wellcare Medicare Advantage	$24,936.03

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$41,292.06

Service Code	MSDRG 136
Min. Negotiated Rate	$11,079.55
Max. Negotiated Rate	$41,292.06
Rate for Payer: Aetna Commercial	$34,235.81
Rate for Payer: Aetna Medicare Advantage	$11,079.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,669.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,669.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,764.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,669.68
Rate for Payer: Cigna Commercial	$21,850.27
Rate for Payer: Cigna Medicare Advantage	$13,764.02
Rate for Payer: Clover Medicare Advantage	$13,075.82
Rate for Payer: EmblemHealth Commercial	$41,292.06
Rate for Payer: Humana Medicare Advantage	$14,176.94
Rate for Payer: Oxford Commercial	$13,655.78
Rate for Payer: UnitedHealthcare Commercial	$15,500.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,764.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14,589.86
Rate for Payer: Wellcare Medicare Advantage	$13,764.02

SINUS GUIDE CATH GC000/GC070

Facility

$512.00

Hospital Charge Code	270335942
Hospital Revenue Code	278
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.90
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

SINUS GUIDE CATH GC000/GC070

Facility

$512.00

Hospital Charge Code	270335942
Hospital Revenue Code	278
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$256.00
Rate for Payer: Aetna Commercial	$153.60
Rate for Payer: Aetna Medicare Advantage	$153.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.56
Rate for Payer: Cigna Commercial	$256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.90
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

SINUS GUIDEWIRE TW35080V

Facility

$385.00

Hospital Charge Code	270335943
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$115.50
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

SINUS GUIDEWIRE TW35080V

Facility

$385.00

Hospital Charge Code	270335943
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

SINUTAB/TAB

Facility

$3.00

Hospital Charge Code	60633889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SINUTAB/TAB

Facility

$3.00

Hospital Charge Code	60633889
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

SIROLIM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3001314
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

SIROLIM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3001314
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

SIROLIMUS

Facility

$94.35

Service Code	HCPCS 80195
Hospital Charge Code	39900010
Hospital Revenue Code	301
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$14.15
Rate for Payer: Qualcare PPO/HMO/WC	$14.15

Know your out-of-pocket cost for care.

All Charges