Heights University Hospital

All Charges

Charge

Type

Setting

Price

SOTALOL 120MG TAB

Facility

$22.91

Service Code	NDC 60505015900
Hospital Charge Code	60635771
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.84
Rate for Payer: Cigna Commercial	$11.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.98
Rate for Payer: Oxford Commercial	$11.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$11.46

SOTALOL 80 MG TAB

Facility

$17.49

Service Code	NDC 245001201
Hospital Charge Code	60628706
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

SOTALOL 80 MG TAB

Facility

$17.49

Service Code	NDC 245001201
Hospital Charge Code	60628706
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$5.25
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.27
Rate for Payer: Oxford Commercial	$8.74
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$8.74

SOTALOL HCL TAB 80MG

Facility

$13.45

Hospital Charge Code	6017784
Hospital Revenue Code	252
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

SOTALOL HCL TAB 80MG

Facility

$13.45

Hospital Charge Code	6017784
Hospital Revenue Code	252
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$6.72
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$6.72

SOTRADECOL 1% 20MG/2ML

Facility

$628.13

Service Code	NDC 67457016202
Hospital Charge Code	606390233
Hospital Revenue Code	250
Min. Negotiated Rate	$94.22
Max. Negotiated Rate	$94.22
Rate for Payer: Qualcare PPO/HMO/WC	$94.22

SOTRADECOL 1% 20MG/2ML

Facility

$628.13

Service Code	NDC 67457016202
Hospital Charge Code	606390233
Hospital Revenue Code	250
Min. Negotiated Rate	$81.66
Max. Negotiated Rate	$314.06
Rate for Payer: Aetna Commercial	$188.44
Rate for Payer: Aetna Medicare Advantage	$188.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.17
Rate for Payer: Cigna Commercial	$314.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.66
Rate for Payer: Oxford Commercial	$314.06
Rate for Payer: Qualcare PPO/HMO/WC	$94.22
Rate for Payer: UnitedHealthcare Commercial	$314.06

SOTRADECOL INJECTION 3%/2

Facility

$61.00

Hospital Charge Code	60633916
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

SOTRADECOL INJECTION 3%/2

Facility

$61.00

Hospital Charge Code	60633916
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

SOTROVIMAB 500MG INJ EUA

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	606390475
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SOTROVIMAB 500MG INJ EUA

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	606390475
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SOTROVIMAB IV INJ & MONITORING

Facility

$2,250.00

Service Code	HCPCS M0247
Hospital Charge Code	3230M0247
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

SOTROVIMAB IV INJ & MONITORING

Facility

$2,250.00

Service Code	HCPCS M0247
Hospital Charge Code	3230M0247
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SOUND FEMALE 16FR METAL 604216

Facility

$347.35

Hospital Charge Code	270660044
Hospital Revenue Code	272
Min. Negotiated Rate	$52.10
Max. Negotiated Rate	$52.10
Rate for Payer: Qualcare PPO/HMO/WC	$52.10

SOUND FEMALE 16FR METAL 604216

Facility

$347.35

Hospital Charge Code	270660044
Hospital Revenue Code	272
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$173.68
Rate for Payer: Aetna Commercial	$104.20
Rate for Payer: Aetna Medicare Advantage	$104.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.57
Rate for Payer: Cigna Commercial	$173.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.16
Rate for Payer: Oxford Commercial	$173.68
Rate for Payer: Qualcare PPO/HMO/WC	$52.10
Rate for Payer: UnitedHealthcare Commercial	$173.68

SOURCE LIGHT MEDT DISP 9560702

Facility

$2,520.85

Hospital Charge Code	270629191
Hospital Revenue Code	272
Min. Negotiated Rate	$378.13
Max. Negotiated Rate	$378.13
Rate for Payer: Qualcare PPO/HMO/WC	$378.13

SOURCE LIGHT MEDT DISP 9560702

Facility

$2,520.85

Hospital Charge Code	270629191
Hospital Revenue Code	272
Min. Negotiated Rate	$327.71
Max. Negotiated Rate	$1,260.42
Rate for Payer: Aetna Commercial	$756.25
Rate for Payer: Aetna Medicare Advantage	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$642.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$642.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$642.82
Rate for Payer: Cigna Commercial	$1,260.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.71
Rate for Payer: Oxford Commercial	$1,260.42
Rate for Payer: Qualcare PPO/HMO/WC	$378.13
Rate for Payer: UnitedHealthcare Commercial	$1,260.42

SP 02 EXTENSION CABLE

Facility

$2,420.00

Hospital Charge Code	270663690
Hospital Revenue Code	279
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.00

SP 02 EXTENSION CABLE

Facility

$2,420.00

Hospital Charge Code	270663690
Hospital Revenue Code	279
Min. Negotiated Rate	$314.60
Max. Negotiated Rate	$1,210.00
Rate for Payer: Aetna Commercial	$726.00
Rate for Payer: Aetna Medicare Advantage	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.10
Rate for Payer: Cigna Commercial	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Oxford Commercial	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.00
Rate for Payer: UnitedHealthcare Commercial	$1,210.00

SP 2.6MM FIBER TAK SUTURE ANCH

Facility

$2,111.50

Service Code	HCPCS C1713
Hospital Charge Code	270705067
Hospital Revenue Code	278
Min. Negotiated Rate	$316.73
Max. Negotiated Rate	$510.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.98
Rate for Payer: Qualcare PPO/HMO/WC	$316.73

SP 2.6MM FIBER TAK SUTURE ANCH

Facility

$2,111.50

Service Code	HCPCS C1713
Hospital Charge Code	270705067
Hospital Revenue Code	278
Min. Negotiated Rate	$316.73
Max. Negotiated Rate	$1,055.75
Rate for Payer: Aetna Commercial	$633.45
Rate for Payer: Aetna Medicare Advantage	$633.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.43
Rate for Payer: Cigna Commercial	$1,055.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.98
Rate for Payer: Qualcare PPO/HMO/WC	$316.73

SPACEBANDER

Facility

$375.00

Hospital Charge Code	270701114
Hospital Revenue Code	250
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SPACEBANDER

Facility

$375.00

Hospital Charge Code	270701114
Hospital Revenue Code	250
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

SPACER 13MM FORTILINK

Facility

$18,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,775.00
Max. Negotiated Rate	$4,477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,477.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,775.00

SPACER 13MM FORTILINK

Facility

$18,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,775.00
Max. Negotiated Rate	$9,250.00
Rate for Payer: Aetna Commercial	$5,550.00
Rate for Payer: Aetna Medicare Advantage	$5,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,717.50
Rate for Payer: Cigna Commercial	$9,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,477.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,775.00

Know your out-of-pocket cost for care.

All Charges