Heights University Hospital

All Charges

Charge

Type

Setting

Price

SOMA (PLAIN)

Facility

$6.00

Hospital Charge Code	60634439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SOMATOMEDIN C

Facility

$613.00

Service Code	HCPCS 84305
Hospital Charge Code	38473084
Hospital Revenue Code	301
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.88
Rate for Payer: Aetna Medicare Advantage	$21.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.90
Rate for Payer: Cigna Commercial	$21.26
Rate for Payer: Cigna Medicare Advantage	$10.63
Rate for Payer: Clover Medicare Advantage	$20.20
Rate for Payer: EmblemHealth Commercial	$63.78
Rate for Payer: Humana Medicare Advantage	$21.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.26
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.54
Rate for Payer: Wellcare Medicare Advantage	$21.26

SOMATOMEDIN C

Facility

$613.00

Service Code	HCPCS 84305
Hospital Charge Code	38473084
Hospital Revenue Code	301
Min. Negotiated Rate	$91.95
Max. Negotiated Rate	$91.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.95

SOMATOSTATIN

Facility

$129.00

Service Code	HCPCS 84307
Hospital Charge Code	38477152
Hospital Revenue Code	301
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

SOMATOSTATIN

Facility

$125.65

Service Code	HCPCS 84307
Hospital Charge Code	39900452
Hospital Revenue Code	301
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$18.85
Rate for Payer: Qualcare PPO/HMO/WC	$18.85

SOMATOSTATIN

Facility

$129.00

Service Code	HCPCS 84307
Hospital Charge Code	38477152
Hospital Revenue Code	301
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$723.02
Rate for Payer: Aetna Better Health Medicaid	$708.84
Rate for Payer: Aetna Commercial	$59.23
Rate for Payer: Aetna Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.98
Rate for Payer: Cigna Commercial	$18.28
Rate for Payer: Cigna Medicare Advantage	$9.14
Rate for Payer: Clover Medicare Advantage	$17.37
Rate for Payer: EmblemHealth Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$18.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.38
Rate for Payer: Wellcare Medicare Advantage	$18.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02

SOMATOSTATIN

Facility

$125.65

Service Code	HCPCS 84307
Hospital Charge Code	39900452
Hospital Revenue Code	301
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$723.02
Rate for Payer: Aetna Better Health Medicaid	$708.84
Rate for Payer: Aetna Commercial	$59.23
Rate for Payer: Aetna Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.98
Rate for Payer: Cigna Commercial	$18.28
Rate for Payer: Cigna Medicare Advantage	$9.14
Rate for Payer: Clover Medicare Advantage	$17.37
Rate for Payer: EmblemHealth Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$18.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.38
Rate for Payer: Wellcare Medicare Advantage	$18.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02

SOMBRERO PATELLA SZ4 7x37MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675368
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SOMBRERO PATELLA SZ4 7x37MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675368
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SONGER CRIMP

Facility

$412.50

Hospital Charge Code	270662291
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Commercial	$123.75
Rate for Payer: Aetna Medicare Advantage	$123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.19
Rate for Payer: Cigna Commercial	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.62
Rate for Payer: Oxford Commercial	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$61.88
Rate for Payer: UnitedHealthcare Commercial	$206.25

SONGER CRIMP

Facility

$412.50

Hospital Charge Code	270662291
Hospital Revenue Code	272
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$61.88
Rate for Payer: Qualcare PPO/HMO/WC	$61.88

SONIC TURBO MINI FLARED

Facility

$375.00

Hospital Charge Code	270660134
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$187.50

SONIC TURBO MINI FLARED

Facility

$375.00

Hospital Charge Code	270660134
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	83653025
Hospital Revenue Code	402
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna Medicare Advantage	$749.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.25
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	83653025
Hospital Revenue Code	402
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$374.85
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

SONOGRAM OB- COMPLETE

Facility

$1,754.00

Service Code	HCPCS 76805
Hospital Charge Code	83653040
Hospital Revenue Code	402
Min. Negotiated Rate	$120.80
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$526.20
Rate for Payer: Aetna Medicare Advantage	$526.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.27
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.02
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.10
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

SONOGRAM OB- COMPLETE

Facility

$1,754.00

Service Code	HCPCS 76805
Hospital Charge Code	83653040
Hospital Revenue Code	402
Min. Negotiated Rate	$263.10
Max. Negotiated Rate	$263.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.10

SONOGRAM OB-REPEAT EA ADDTL FE

Facility

$1,278.20

Service Code	HCPCS 76816
Hospital Charge Code	83653075
Hospital Revenue Code	402
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$191.73
Rate for Payer: Qualcare PPO/HMO/WC	$191.73

SONOGRAM OB-REPEAT EA ADDTL FE

Facility

$1,278.20

Service Code	HCPCS 76816
Hospital Charge Code	83653075
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Better Health Medicaid	$399.68
Rate for Payer: Aetna Commercial	$383.46
Rate for Payer: Aetna Medicare Advantage	$383.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.94
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.17
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.73
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67

SORB-10 RENAL

Facility

$16.85

Hospital Charge Code	270606196
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

SORB-10 RENAL

Facility

$16.85

Hospital Charge Code	270606196
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$5.05
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.43

SORBAFIX 30-SHT ABSRBBLE FIX

Facility

$2,700.00

Hospital Charge Code	270645935
Hospital Revenue Code	272
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,350.00

SORBAFIX 30-SHT ABSRBBLE FIX

Facility

$2,700.00

Hospital Charge Code	270645935
Hospital Revenue Code	272
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

SORB CARTRIDGE HI****

Facility

$281.00

Hospital Charge Code	270610922
Hospital Revenue Code	272
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

SORB CARTRIDGE HI****

Facility

$281.00

Hospital Charge Code	270610922
Hospital Revenue Code	272
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$140.50
Rate for Payer: Aetna Commercial	$84.30
Rate for Payer: Aetna Medicare Advantage	$84.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.66
Rate for Payer: Cigna Commercial	$140.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.53
Rate for Payer: Oxford Commercial	$140.50
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$140.50

Know your out-of-pocket cost for care.

All Charges