Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPONGE TONSIL PK MED 10604

Facility

$9.65

Hospital Charge Code	270600313
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

SPONGE TONSIL PK SM 7208

Facility

$9.65

Hospital Charge Code	270600314
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

SPONGE TONSIL PK SM 7208

Facility

$9.65

Hospital Charge Code	270600314
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SPONGE TONSIL PK XLG 10608

Facility

$13.65

Hospital Charge Code	270607223
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

SPONGE TONSIL PK XLG 10608

Facility

$13.65

Hospital Charge Code	270607223
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

SPONGE VISITEC4X4 RAYTEC7317

Facility

$2.66

Hospital Charge Code	270102237
Hospital Revenue Code	272
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.40

SPONGE VISITEC4X4 RAYTEC7317

Facility

$2.66

Hospital Charge Code	270102237
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$1.33
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: Aetna Medicare Advantage	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.68
Rate for Payer: Cigna Commercial	$1.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.35
Rate for Payer: Oxford Commercial	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.40
Rate for Payer: UnitedHealthcare Commercial	$1.33

SPONGE WECKSORB CYLINDRICAL

Facility

$181.50

Hospital Charge Code	270655901
Hospital Revenue Code	271
Min. Negotiated Rate	$23.59
Max. Negotiated Rate	$90.75
Rate for Payer: Aetna Commercial	$54.45
Rate for Payer: Aetna Medicare Advantage	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.28
Rate for Payer: Cigna Commercial	$90.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.59
Rate for Payer: Oxford Commercial	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.23
Rate for Payer: UnitedHealthcare Commercial	$90.75

SPONGE WECKSORB CYLINDRICAL

Facility

$181.50

Hospital Charge Code	270655901
Hospital Revenue Code	271
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$27.23
Rate for Payer: Qualcare PPO/HMO/WC	$27.23

SPONGE XRAY DETECTABLE 4x4

Facility

$2.66

Hospital Charge Code	27061520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$1.33
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: Aetna Medicare Advantage	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.68
Rate for Payer: Cigna Commercial	$1.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.35
Rate for Payer: Oxford Commercial	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.40
Rate for Payer: UnitedHealthcare Commercial	$1.33

SPONGE XRAY DETECTABLE 4x4

Facility

$2.66

Hospital Charge Code	27061520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.40

SPORANOX/100MG/CAP/U/D

Facility

$163.21

Service Code	NDC 50458029001
Hospital Charge Code	60634825
Hospital Revenue Code	250
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$24.48
Rate for Payer: Qualcare PPO/HMO/WC	$24.48

SPORANOX/100MG/CAP/U/D

Facility

$163.21

Service Code	NDC 50458029001
Hospital Charge Code	60634825
Hospital Revenue Code	250
Min. Negotiated Rate	$21.22
Max. Negotiated Rate	$81.61
Rate for Payer: Aetna Commercial	$48.96
Rate for Payer: Aetna Medicare Advantage	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$81.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.22
Rate for Payer: Oxford Commercial	$81.61
Rate for Payer: Qualcare PPO/HMO/WC	$24.48
Rate for Payer: UnitedHealthcare Commercial	$81.61

SPORANOX 10MG/ML KIT250ML

Facility

$600.00

Hospital Charge Code	60635363
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

SPORANOX 10MG/ML KIT250ML

Facility

$600.00

Hospital Charge Code	60635363
Hospital Revenue Code	250
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$300.00

SPORTS TAPE

Facility

$44.00

Hospital Charge Code	84202125
Hospital Revenue Code	270
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

SPORTS TAPE

Facility

$44.00

Hospital Charge Code	84202125
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SPOT (INDIA INK)

Facility

$190.00

Hospital Charge Code	270630596
Hospital Revenue Code	270
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$95.00

SPOT (INDIA INK)

Facility

$190.00

Hospital Charge Code	270630596
Hospital Revenue Code	270
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

SPOTLIGHT PORTS

Facility

$4,750.00

Hospital Charge Code	270671359
Hospital Revenue Code	272
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$712.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

SPOTLIGHT PORTS

Facility

$4,750.00

Hospital Charge Code	270671359
Hospital Revenue Code	272
Min. Negotiated Rate	$617.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$2,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Commercial	$2,375.00

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$39,521.49

Service Code	MSDRG 537
Min. Negotiated Rate	$10,413.88
Max. Negotiated Rate	$39,521.49
Rate for Payer: Aetna Commercial	$32,178.89
Rate for Payer: Aetna Medicare Advantage	$10,413.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,739.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,739.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,173.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,739.99
Rate for Payer: Cigna Commercial	$20,537.49
Rate for Payer: Cigna Medicare Advantage	$13,173.83
Rate for Payer: Clover Medicare Advantage	$12,515.14
Rate for Payer: EmblemHealth Commercial	$39,521.49
Rate for Payer: Humana Medicare Advantage	$13,569.04
Rate for Payer: Oxford Commercial	$12,835.33
Rate for Payer: UnitedHealthcare Commercial	$14,569.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,173.83
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13,964.26
Rate for Payer: Wellcare Medicare Advantage	$13,173.83

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$32,729.46

Service Code	MSDRG 538
Min. Negotiated Rate	$7,860.33
Max. Negotiated Rate	$32,729.46
Rate for Payer: Aetna Commercial	$24,288.42
Rate for Payer: Aetna Medicare Advantage	$7,860.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,572.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,572.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,909.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,572.57
Rate for Payer: Cigna Commercial	$15,501.58
Rate for Payer: Cigna Medicare Advantage	$10,909.82
Rate for Payer: Clover Medicare Advantage	$10,364.33
Rate for Payer: EmblemHealth Commercial	$32,729.46
Rate for Payer: Humana Medicare Advantage	$11,237.11
Rate for Payer: Oxford Commercial	$9,688.03
Rate for Payer: UnitedHealthcare Commercial	$10,996.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,909.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,564.41
Rate for Payer: Wellcare Medicare Advantage	$10,909.82

SPRAYCYTE (FIXATIVE CYTOLOGY)

Facility

$51.35

Hospital Charge Code	270657182
Hospital Revenue Code	270
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$7.70

SPRAYCYTE (FIXATIVE CYTOLOGY)

Facility

$51.35

Hospital Charge Code	270657182
Hospital Revenue Code	270
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$25.68
Rate for Payer: UnitedHealthcare Commercial	$25.68
Rate for Payer: Aetna Commercial	$15.40
Rate for Payer: Aetna Medicare Advantage	$15.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.09
Rate for Payer: Cigna Commercial	$25.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.68
Rate for Payer: Oxford Commercial	$25.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.70

Know your out-of-pocket cost for care.

All Charges