Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPECIFIC GRAVITY, URINE

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	3003555
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECIFIC GRAVITY, URINE

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	3003555
Hospital Revenue Code	307
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.28
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: Cigna Medicare Advantage	$1.74
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.69
Rate for Payer: Wellcare Medicare Advantage	$3.48

SPECIFIC GRAVITY, URINE***

Facility

$13.00

Service Code	HCPCS 81000
Hospital Charge Code	3030533
Hospital Revenue Code	309
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.02
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.73
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: Cigna Medicare Advantage	$2.01
Rate for Payer: Clover Medicare Advantage	$3.82
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.26
Rate for Payer: Wellcare Medicare Advantage	$4.02

SPECIFIC GRAVITY, URINE***

Facility

$13.00

Service Code	HCPCS 81000
Hospital Charge Code	3030533
Hospital Revenue Code	309
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SPECIMEN BAG

Facility

$268.00

Hospital Charge Code	270338724
Hospital Revenue Code	272
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.20

SPECIMEN BAG

Facility

$268.00

Hospital Charge Code	270338724
Hospital Revenue Code	272
Min. Negotiated Rate	$34.84
Max. Negotiated Rate	$134.00
Rate for Payer: Aetna Commercial	$80.40
Rate for Payer: Aetna Medicare Advantage	$80.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.34
Rate for Payer: Cigna Commercial	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.84
Rate for Payer: Oxford Commercial	$134.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.20
Rate for Payer: UnitedHealthcare Commercial	$134.00

SPECIMEN COLLECTION FEE

Facility

$26.00

Hospital Charge Code	3010451
Hospital Revenue Code	309
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPECIMEN COLLECTION FEE

Facility

$26.00

Hospital Charge Code	3010451
Hospital Revenue Code	309
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

SPECIMEN INFECT AGNT CONCNT

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	401087015
Hospital Revenue Code	306
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

SPECIMEN INFECT AGNT CONCNT

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	401087015
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECTAZOLE 1%/15GM

Facility

$66.00

Hospital Charge Code	60633917
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
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	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

SPECTAZOLE 1%/15GM

Facility

$66.00

Hospital Charge Code	60633917
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

SPECTINOMYCIN INJ IM 2GM

Facility

$221.25

Hospital Charge Code	60627327
Hospital Revenue Code	636
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$110.62
Rate for Payer: Aetna Commercial	$66.38
Rate for Payer: Aetna Medicare Advantage	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.42
Rate for Payer: Cigna Commercial	$110.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.19

SPECTINOMYCIN INJ IM 2GM

Facility

$221.25

Hospital Charge Code	60627327
Hospital Revenue Code	636
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$53.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.19

SPECTRAPENILEPROSTHES9.5X16CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270663878
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$7,946.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRAPENILEPROSTHES9.5X16CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270663878
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$16,417.50
Rate for Payer: Aetna Commercial	$9,850.50
Rate for Payer: Aetna Medicare Advantage	$9,850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,372.92
Rate for Payer: Cigna Commercial	$16,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRA PENILE PROSTHESIS

Facility

$57,475.00

Service Code	HCPCS C2622
Hospital Charge Code	270685525
Hospital Revenue Code	278
Min. Negotiated Rate	$8,621.25
Max. Negotiated Rate	$28,737.50
Rate for Payer: Aetna Commercial	$17,242.50
Rate for Payer: Aetna Medicare Advantage	$17,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,656.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,656.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,656.12
Rate for Payer: Cigna Commercial	$28,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,908.95
Rate for Payer: Qualcare PPO/HMO/WC	$8,621.25

SPECTRA PENILE PROSTHESIS

Facility

$57,475.00

Service Code	HCPCS C2622
Hospital Charge Code	270685525
Hospital Revenue Code	278
Min. Negotiated Rate	$8,621.25
Max. Negotiated Rate	$13,908.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,908.95
Rate for Payer: Qualcare PPO/HMO/WC	$8,621.25

SPECTRAPENILEPROSTHESIS12X12CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270661187
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$7,946.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRAPENILEPROSTHESIS12X12CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270661187
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$16,417.50
Rate for Payer: Aetna Commercial	$9,850.50
Rate for Payer: Aetna Medicare Advantage	$9,850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,372.92
Rate for Payer: Cigna Commercial	$16,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRA REAR TIP EXTENDER 9.5

Facility

$21.40

Service Code	HCPCS C1813
Hospital Charge Code	270663879
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$6.42
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SPECTRA REAR TIP EXTENDER 9.5

Facility

$21.40

Service Code	HCPCS C1813
Hospital Charge Code	270663879
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SPECULA KLEENSPEC VAGINAL DISP

Facility

$484.35

Hospital Charge Code	270654035
Hospital Revenue Code	272
Min. Negotiated Rate	$72.65
Max. Negotiated Rate	$72.65
Rate for Payer: Qualcare PPO/HMO/WC	$72.65

SPECULA KLEENSPEC VAGINAL DISP

Facility

$484.35

Hospital Charge Code	270654035
Hospital Revenue Code	272
Min. Negotiated Rate	$62.97
Max. Negotiated Rate	$242.18
Rate for Payer: Aetna Commercial	$145.31
Rate for Payer: Aetna Medicare Advantage	$145.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.51
Rate for Payer: Cigna Commercial	$242.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.97
Rate for Payer: Oxford Commercial	$242.18
Rate for Payer: Qualcare PPO/HMO/WC	$72.65
Rate for Payer: UnitedHealthcare Commercial	$242.18

SPECULUM VAG DISPOS W/BUILT IN

Facility

$21.27

Hospital Charge Code	270654043
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna Commercial	$6.38
Rate for Payer: Aetna Medicare Advantage	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.77
Rate for Payer: Oxford Commercial	$10.63
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$10.63

Know your out-of-pocket cost for care.

All Charges