Heights University Hospital

All Charges

Charge

Type

Setting

Price

SREPS/N/A/G/TR/E; 2.6-7.5CM

Facility

$2,090.76

Service Code	HCPCS 12002
Hospital Charge Code	1600000678
Hospital Revenue Code	360
Min. Negotiated Rate	$313.61
Max. Negotiated Rate	$313.61
Rate for Payer: Qualcare PPO/HMO/WC	$313.61

SREPS/N/A/G/TR/E; 2.6-7.5CM

Facility

$2,090.76

Service Code	HCPCS 12002
Hospital Charge Code	1600000678
Hospital Revenue Code	360
Min. Negotiated Rate	$271.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$627.23
Rate for Payer: Aetna Medicare Advantage	$627.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.14
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.61
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

SRP AUTOANTIBODIES

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	3847978
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
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	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

SRP AUTOANTIBODIES

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	3847978
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SRS LINEAR BASED

Facility

$4,966.15

Service Code	HCPCS 77372
Hospital Charge Code	85000670
Hospital Revenue Code	333
Min. Negotiated Rate	$744.92
Max. Negotiated Rate	$744.92
Rate for Payer: Qualcare PPO/HMO/WC	$744.92

SRS LINEAR BASED

Facility

$4,966.15

Service Code	HCPCS 77372
Hospital Charge Code	85000670
Hospital Revenue Code	333
Min. Negotiated Rate	$645.60
Max. Negotiated Rate	$17,539.66
Rate for Payer: Aetna Commercial	$1,489.85
Rate for Payer: Aetna Medicare Advantage	$1,489.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,266.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,266.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,266.37
Rate for Payer: Cigna Commercial	$17,539.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$645.60
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$744.92
Rate for Payer: UnitedHealthcare Commercial	$11,456.00

SRS MULTISOURCE

Facility

$51,303.61

Service Code	HCPCS 77371
Hospital Charge Code	85000665
Hospital Revenue Code	333
Min. Negotiated Rate	$6,669.47
Max. Negotiated Rate	$17,539.66
Rate for Payer: Aetna Commercial	$15,391.08
Rate for Payer: Aetna Medicare Advantage	$15,391.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,082.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,082.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,082.42
Rate for Payer: Cigna Commercial	$17,539.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,669.47
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,695.54
Rate for Payer: UnitedHealthcare Commercial	$11,456.00

SRS MULTISOURCE

Facility

$51,303.61

Service Code	HCPCS 77371
Hospital Charge Code	85000665
Hospital Revenue Code	333
Min. Negotiated Rate	$7,695.54
Max. Negotiated Rate	$7,695.54
Rate for Payer: Qualcare PPO/HMO/WC	$7,695.54

SRW CORT LOPROF SLF-TPN 3.5X70

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681558
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5X70

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681558
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x80

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681559
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x80

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681559
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x90

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681560
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x90

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681560
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x95

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681561
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x95

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681561
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SS-A & SS-B (SJOGREN'S) I

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027A
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
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	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

SS-A & SS-B (SJOGREN'S) I

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SS-A & SS-B (SJOGREN'S) II

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SS-A & SS-B (SJOGREN'S) II

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027B
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
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	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

SSB LA ENA - SJORGEN'S AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006898
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

SSB LA ENA - SJORGEN'S AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006898
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

SS CEMENT RESTRICTOR TRAIL 1

Facility

$547.00

Hospital Charge Code	270332108
Hospital Revenue Code	272
Min. Negotiated Rate	$71.11
Max. Negotiated Rate	$273.50
Rate for Payer: Aetna Commercial	$164.10
Rate for Payer: Aetna Medicare Advantage	$164.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.49
Rate for Payer: Cigna Commercial	$273.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.11
Rate for Payer: Oxford Commercial	$273.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.05
Rate for Payer: UnitedHealthcare Commercial	$273.50

SS CEMENT RESTRICTOR TRAIL 1

Facility

$547.00

Hospital Charge Code	270332108
Hospital Revenue Code	272
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$82.05
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

SSD 1%/400GM

Facility

$87.00

Hospital Charge Code	60633918
Hospital Revenue Code	250
Min. Negotiated Rate	$11.31
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Oxford Commercial	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$43.50

Know your out-of-pocket cost for care.

All Charges