Heights University Hospital

All Charges

Charge

Type

Setting

Price

SOLIDLOK HEX TIP 3.5MM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	270689271
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SOLIDLOK HEX TIP 3.5MM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	270689271
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SOLID SCREWDRIVER SHANK S-CP

Facility

$605.00

Hospital Charge Code	270686086
Hospital Revenue Code	272
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$90.75

SOLID SCREWDRIVER SHANK S-CP

Facility

$605.00

Hospital Charge Code	270686086
Hospital Revenue Code	272
Min. Negotiated Rate	$78.65
Max. Negotiated Rate	$302.50
Rate for Payer: Aetna Commercial	$181.50
Rate for Payer: Aetna Medicare Advantage	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.28
Rate for Payer: Cigna Commercial	$302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Oxford Commercial	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$90.75
Rate for Payer: UnitedHealthcare Commercial	$302.50

SOLIUM CHLOR 0.9% IRRIG 3000ml

Facility

$35.00

Hospital Charge Code	270649754
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$10.50
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$17.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$17.50

SOLIUM CHLOR 0.9% IRRIG 3000ml

Facility

$35.00

Hospital Charge Code	270649754
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

SOLUABLE TRANSFERRING RECEPTOR

Facility

$667.59

Service Code	HCPCS 84238
Hospital Charge Code	39900451
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SOLUABLE TRANSFERRING RECEPTOR

Facility

$667.59

Service Code	HCPCS 84238
Hospital Charge Code	39900451
Hospital Revenue Code	301
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$133.99
Rate for Payer: Aetna Commercial	$118.49
Rate for Payer: Aetna Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.99
Rate for Payer: Cigna Commercial	$36.57
Rate for Payer: Cigna Medicare Advantage	$18.29
Rate for Payer: Clover Medicare Advantage	$34.74
Rate for Payer: EmblemHealth Commercial	$109.71
Rate for Payer: Humana Medicare Advantage	$37.67
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	$36.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$38.76
Rate for Payer: Wellcare Medicare Advantage	$36.57

SOLUABLE TRANSFERRIN RECEPTOR

Facility

$253.45

Service Code	HCPCS 84238
Hospital Charge Code	3009165
Hospital Revenue Code	301
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$133.99
Rate for Payer: Aetna Commercial	$118.49
Rate for Payer: Aetna Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.99
Rate for Payer: Cigna Commercial	$36.57
Rate for Payer: Cigna Medicare Advantage	$18.29
Rate for Payer: Clover Medicare Advantage	$34.74
Rate for Payer: EmblemHealth Commercial	$109.71
Rate for Payer: Humana Medicare Advantage	$37.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$38.76
Rate for Payer: Wellcare Medicare Advantage	$36.57

SOLUABLE TRANSFERRIN RECEPTOR

Facility

$253.45

Service Code	HCPCS 84238
Hospital Charge Code	3009165
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$290.00

Service Code	HCPCS 84238
Hospital Charge Code	38472301
Hospital Revenue Code	301
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$290.00

Service Code	HCPCS 84238
Hospital Charge Code	38472301
Hospital Revenue Code	301
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$133.99
Rate for Payer: Aetna Commercial	$118.49
Rate for Payer: Aetna Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.99
Rate for Payer: Cigna Commercial	$36.57
Rate for Payer: Cigna Medicare Advantage	$18.29
Rate for Payer: Clover Medicare Advantage	$34.74
Rate for Payer: EmblemHealth Commercial	$109.71
Rate for Payer: Humana Medicare Advantage	$37.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$38.76
Rate for Payer: Wellcare Medicare Advantage	$36.57

SOLU-MEDROL/1000MG

Facility

$66.00

Hospital Charge Code	60633911
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SOLU-MEDROL/1000MG

Facility

$66.00

Hospital Charge Code	60633911
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SOLUMEDROL 1 GRAM VIAL

Facility

$120.00

Hospital Charge Code	60635634
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.04
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

SOLUMEDROL 1 GRAM VIAL

Facility

$120.00

Hospital Charge Code	60635634
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$29.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.04
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

SOLUMEDROL 40MG

Facility

$14.47

Hospital Charge Code	60635755
Hospital Revenue Code	636
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

SOLUMEDROL 40MG

Facility

$14.47

Hospital Charge Code	60635755
Hospital Revenue Code	636
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$4.34
Rate for Payer: Aetna Medicare Advantage	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.69
Rate for Payer: Cigna Commercial	$7.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

SOLU-MEDROL 40MG VIAL

Facility

$16.00

Hospital Charge Code	83652591
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SOLU-MEDROL 40MG VIAL

Facility

$16.00

Hospital Charge Code	83652591
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
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	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SOLUMEDROL 40MG VIAL

Facility

$18.00

Hospital Charge Code	60635248
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SOLUMEDROL 40MG VIAL

Facility

$18.00

Hospital Charge Code	60635248
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SOLUTION 0.9% NACL IRRG 2B7124

Facility

$19.25

Hospital Charge Code	270303230
Hospital Revenue Code	272
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

SOLUTION 0.9% NACL IRRG 2B7124

Facility

$19.25

Hospital Charge Code	270303230
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

SOLUTION 9NACL IRR 1000 2B7231

Facility

$154.50

Hospital Charge Code	270629461
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$23.18

Know your out-of-pocket cost for care.

All Charges