Heights University Hospital

All Charges

Charge

Type

Setting

Price

SM INTESTINE F/U MULT ADD-ON

Facility

$5,100.00

Service Code	HCPCS 74248
Hospital Charge Code	404174248
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SML BONE FIXATION SYST 1.6MM

Facility

$575.00

Hospital Charge Code	270339447
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

SML BONE FIXATION SYST 1.6MM

Facility

$575.00

Hospital Charge Code	270339447
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

SMN1 COPY NUMBER ANALYSIS

Facility

$200.00

Service Code	HCPCS 81401
Hospital Charge Code	3038122
Hospital Revenue Code	310
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SMN1 COPY NUMBER ANALYSIS

Facility

$200.00

Service Code	HCPCS 81401
Hospital Charge Code	3038122
Hospital Revenue Code	310
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$501.97
Rate for Payer: Aetna Commercial	$443.88
Rate for Payer: Aetna Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.97
Rate for Payer: Cigna Commercial	$137.00
Rate for Payer: Cigna Medicare Advantage	$68.50
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$145.22
Rate for Payer: Wellcare Medicare Advantage	$137.00

SMOFLIPID 20% FAT EMULS 500ML

Facility

$273.36

Service Code	NDC 63323082050
Hospital Charge Code	606390484
Hospital Revenue Code	250
Min. Negotiated Rate	$35.54
Max. Negotiated Rate	$136.68
Rate for Payer: Aetna Commercial	$82.01
Rate for Payer: Aetna Medicare Advantage	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.71
Rate for Payer: Cigna Commercial	$136.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.54
Rate for Payer: Oxford Commercial	$136.68
Rate for Payer: Qualcare PPO/HMO/WC	$41.00
Rate for Payer: UnitedHealthcare Commercial	$136.68

SMOFLIPID 20% FAT EMULS 500ML

Facility

$273.36

Service Code	NDC 63323082050
Hospital Charge Code	606390484
Hospital Revenue Code	250
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.00

SMOOTH LOCK PEG 2.2MM X 16MM

Facility

$650.00

Hospital Charge Code	270663847
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SMOOTH LOCK PEG 2.2MM X 16MM

Facility

$650.00

Hospital Charge Code	270663847
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SMOOTH LOCK PEG 2.2MM X 18MM

Facility

$650.00

Hospital Charge Code	270663848
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SMOOTH LOCK PEG 2.2MM X 18MM

Facility

$650.00

Hospital Charge Code	270663848
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SMOOTH LOCK PEG 2.2MM X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681157
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681157
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$140.40
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 22MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681158
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$140.40
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 22MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681158
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH MOD + PROF XTRA 465CC

Facility

$7,625.00

Hospital Charge Code	270703175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.75
Max. Negotiated Rate	$1,845.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75

SMOOTH MOD + PROF XTRA 465CC

Facility

$7,625.00

Hospital Charge Code	270703175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.75
Max. Negotiated Rate	$3,812.50
Rate for Payer: Aetna Commercial	$2,287.50
Rate for Payer: Aetna Medicare Advantage	$2,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,944.38
Rate for Payer: Cigna Commercial	$3,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75

SMOOTH MUSCLE AB SCRN

Facility

$187.25

Service Code	HCPCS 83516
Hospital Charge Code	3003639
Hospital Revenue Code	302
Min. Negotiated Rate	$28.09
Max. Negotiated Rate	$28.09
Rate for Payer: Qualcare PPO/HMO/WC	$28.09

SMOOTH MUSCLE AB SCRN

Facility

$187.25

Service Code	HCPCS 83516
Hospital Charge Code	3003639
Hospital Revenue Code	302
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

SMOOTH MUSCLE AB WITH REFLEX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900366
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

SMOOTH MUSCLE AB WITH REFLEX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900366
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SMOOTH MUSCLE ANTIBODIES

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38476066
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

SMOOTH MUSCLE ANTIBODIES

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38476066
Hospital Revenue Code	302
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SMOOTH MUSCLE ANTIBODY SCREEN

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38479408
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

SMOOTH MUSCLE ANTIBODY SCREEN

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38479408
Hospital Revenue Code	302
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

Know your out-of-pocket cost for care.

All Charges