Heights University Hospital

All Charges

Charge

Type

Setting

Price

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SOAP CASTILE ENE 2/3 OZ

Facility

$2.45

Hospital Charge Code	270302000
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

SOAP CASTILE ENE 2/3 OZ

Facility

$2.45

Hospital Charge Code	270302000
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SOCK ARTHROSCOPY SPEC

Facility

$29.65

Hospital Charge Code	270601227
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

SOCK ARTHROSCOPY SPEC

Facility

$4.27

Hospital Charge Code	2707601227
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

SOCK ARTHROSCOPY SPEC

Facility

$29.65

Hospital Charge Code	270601227
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

SOCK ARTHROSCOPY SPEC

Facility

$4.27

Hospital Charge Code	2707601227
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$2.13
Rate for Payer: Aetna Commercial	$1.28
Rate for Payer: Aetna Medicare Advantage	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.09
Rate for Payer: Cigna Commercial	$2.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.56
Rate for Payer: Oxford Commercial	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$2.13

SOCKET NON-SLIP 1/2 DRIVE

Facility

$449.75

Hospital Charge Code	270617608
Hospital Revenue Code	272
Min. Negotiated Rate	$58.47
Max. Negotiated Rate	$224.88
Rate for Payer: Aetna Commercial	$134.93
Rate for Payer: Aetna Medicare Advantage	$134.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.69
Rate for Payer: Cigna Commercial	$224.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.47
Rate for Payer: Oxford Commercial	$224.88
Rate for Payer: Qualcare PPO/HMO/WC	$67.46
Rate for Payer: UnitedHealthcare Commercial	$224.88

SOCKET NON-SLIP 1/2 DRIVE

Facility

$449.75

Hospital Charge Code	270617608
Hospital Revenue Code	272
Min. Negotiated Rate	$67.46
Max. Negotiated Rate	$67.46
Rate for Payer: Qualcare PPO/HMO/WC	$67.46

SOD ACETATE INJ/40MEQ/20M

Facility

$7.00

Hospital Charge Code	60634293
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SOD ACETATE INJ/40MEQ/20M

Facility

$7.00

Hospital Charge Code	60634293
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

SODA SORB PRE-PACK

Facility

$50.45

Hospital Charge Code	270070085
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$15.13
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.56
Rate for Payer: Oxford Commercial	$25.23
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$25.23

SODA SORB PRE-PACK

Facility

$47.72

Hospital Charge Code	27070085
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$23.86
Rate for Payer: Aetna Commercial	$14.32
Rate for Payer: Aetna Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.17
Rate for Payer: Cigna Commercial	$23.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.20
Rate for Payer: Oxford Commercial	$23.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.16
Rate for Payer: UnitedHealthcare Commercial	$23.86

SODA SORB PRE-PACK

Facility

$50.45

Hospital Charge Code	270070085
Hospital Revenue Code	272
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

SODA SORB PRE-PACK

Facility

$47.72

Hospital Charge Code	27070085
Hospital Revenue Code	270
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$7.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.16

SODBIC 7.5% 50ML

Facility

$1.00

Hospital Charge Code	60635515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

SODBIC 7.5% 50ML

Facility

$1.00

Hospital Charge Code	60635515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SOD BICARBONATE ABBO 4.2%

Facility

$8.00

Hospital Charge Code	60634421
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

SOD BICARBONATE ABBO 4.2%

Facility

$8.00

Hospital Charge Code	60634421
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

Know your out-of-pocket cost for care.

All Charges