Heights University Hospital

All Charges

Charge

Type

Setting

Price

SIROLIMUS

Facility

$94.35

Service Code	HCPCS 80195
Hospital Charge Code	39900010
Hospital Revenue Code	301
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.49
Rate for Payer: Aetna Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.31
Rate for Payer: Cigna Commercial	$13.73
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.55
Rate for Payer: Wellcare Medicare Advantage	$13.73

SIROLIMUS

Facility

$390.00

Service Code	HCPCS 80195
Hospital Charge Code	38477217
Hospital Revenue Code	301
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.49
Rate for Payer: Aetna Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.31
Rate for Payer: Cigna Commercial	$13.73
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
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	$13.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.55
Rate for Payer: Wellcare Medicare Advantage	$13.73

SIROLIMUS

Facility

$390.00

Service Code	HCPCS 80195
Hospital Charge Code	38477217
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SI SCREW FULLY THREADED 12X50M

Facility

$15,625.00

Hospital Charge Code	270702056
Hospital Revenue Code	270
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$2,343.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

SI SCREW FULLY THREADED 12X50M

Facility

$15,625.00

Hospital Charge Code	270702056
Hospital Revenue Code	270
Min. Negotiated Rate	$2,031.25
Max. Negotiated Rate	$7,812.50
Rate for Payer: Aetna Commercial	$4,687.50
Rate for Payer: Aetna Medicare Advantage	$4,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,031.25
Rate for Payer: Oxford Commercial	$7,812.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75
Rate for Payer: UnitedHealthcare Commercial	$7,812.50

SI SCREW FULLY THREADED 12X70M

Facility

$15,625.00

Hospital Charge Code	270702057
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$3,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

SI SCREW FULLY THREADED 12X70M

Facility

$15,625.00

Hospital Charge Code	270702057
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$7,812.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75
Rate for Payer: Aetna Commercial	$4,687.50
Rate for Payer: Aetna Medicare Advantage	$4,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	36680076T
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$11,284.31
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,889.87
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	41100076T
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$11,284.31
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,889.87
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	41100076T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

S&I STENT/CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0076T
Hospital Charge Code	36680076T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

SITAGLIPTIN PHOSPHATE 100MG TB

Facility

$88.57

Service Code	NDC 6027728
Hospital Charge Code	60630092
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

SITAGLIPTIN PHOSPHATE 100MG TB

Facility

$88.57

Service Code	NDC 6027728
Hospital Charge Code	60630092
Hospital Revenue Code	250
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$44.28
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.59
Rate for Payer: Cigna Commercial	$44.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.51
Rate for Payer: Oxford Commercial	$44.28
Rate for Payer: Qualcare PPO/HMO/WC	$13.29
Rate for Payer: UnitedHealthcare Commercial	$44.28

Sitagliptin Phosphate 25 MG TA

Facility

$88.57

Service Code	NDC 6022128
Hospital Charge Code	60630090
Hospital Revenue Code	250
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$44.28
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.59
Rate for Payer: Cigna Commercial	$44.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.51
Rate for Payer: Oxford Commercial	$44.28
Rate for Payer: Qualcare PPO/HMO/WC	$13.29
Rate for Payer: UnitedHealthcare Commercial	$44.28

Sitagliptin Phosphate 25 MG TA

Facility

$88.57

Service Code	NDC 6022128
Hospital Charge Code	60630090
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

SITAGLIPTIN PHOSPHATE 50MG TAB

Facility

$88.57

Service Code	NDC 6011228
Hospital Charge Code	60630091
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$13.29

SITAGLIPTIN PHOSPHATE 50MG TAB

Facility

$88.57

Service Code	NDC 6011228
Hospital Charge Code	60630091
Hospital Revenue Code	250
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$44.28
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.59
Rate for Payer: Cigna Commercial	$44.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.51
Rate for Payer: Oxford Commercial	$44.28
Rate for Payer: Qualcare PPO/HMO/WC	$13.29
Rate for Payer: UnitedHealthcare Commercial	$44.28

SITE SOLUTION ADMIN SET

Facility

$36.00

Hospital Charge Code	270331116
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.68
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$18.00

SITE SOLUTION ADMIN SET

Facility

$36.00

Hospital Charge Code	270331116
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

SITZ BATH

Facility

$10.74

Hospital Charge Code	270649928
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

SITZ BATH

Facility

$10.74

Hospital Charge Code	270649928
Hospital Revenue Code	272
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.37
Rate for Payer: Aetna Commercial	$3.22
Rate for Payer: Aetna Medicare Advantage	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.74
Rate for Payer: Cigna Commercial	$5.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$5.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$5.37

SITZ-BATH **************

Facility

$10.00

Hospital Charge Code	8001596
Hospital Revenue Code	279
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

SITZ-BATH **************

Facility

$10.00

Hospital Charge Code	8001596
Hospital Revenue Code	279
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

SITZ BATH PLASTIC

Facility

$5.32

Hospital Charge Code	270301980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SITZ BATH PLASTIC

Facility

$5.32

Hospital Charge Code	270301980
Hospital Revenue Code	270
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$2.66
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.69
Rate for Payer: Oxford Commercial	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.66

Know your out-of-pocket cost for care.

All Charges