Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUMP PUMP DISP AN-42

Facility

$417.15

Hospital Charge Code	270650475
Hospital Revenue Code	272
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$208.57
Rate for Payer: Aetna Commercial	$125.14
Rate for Payer: Aetna Medicare Advantage	$125.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.37
Rate for Payer: Cigna Commercial	$208.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.23
Rate for Payer: Oxford Commercial	$208.57
Rate for Payer: Qualcare PPO/HMO/WC	$62.57
Rate for Payer: UnitedHealthcare Commercial	$208.57

SUMP PUMP DISP AN-42

Facility

$417.15

Hospital Charge Code	270650475
Hospital Revenue Code	272
Min. Negotiated Rate	$62.57
Max. Negotiated Rate	$62.57
Rate for Payer: Qualcare PPO/HMO/WC	$62.57

SUMYCIN/125MG/5ML

Facility

$23.00

Hospital Charge Code	60633933
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

SUMYCIN/125MG/5ML

Facility

$23.00

Hospital Charge Code	60633933
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633934
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633934
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SUMYCIN 250/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633937
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SUMYCIN 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633937
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SUMYCIN 500/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633938
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SUMYCIN 500/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633938
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SUPERCORE BX INSTRMT 14G 15cm

Facility

$180.00

Hospital Charge Code	270645786
Hospital Revenue Code	271
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

SUPERCORE BX INSTRMT 14G 15cm

Facility

$180.00

Hospital Charge Code	270645786
Hospital Revenue Code	271
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$90.00

SUPERF SFT TISS BX LEG/ANKLE

Facility

$7,612.30

Service Code	HCPCS 27613
Hospital Charge Code	16000709
Hospital Revenue Code	360
Min. Negotiated Rate	$989.60
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,283.69
Rate for Payer: Aetna Medicare Advantage	$2,283.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,941.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,941.14
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	$1,941.14
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.60
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

SUPERF SFT TISS BX LEG/ANKLE

Facility

$7,612.30

Service Code	HCPCS 27613
Hospital Charge Code	16000709
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

SUPERSHEATH INTRO WO GWIRE 12F

Facility

$102.90

Service Code	HCPCS C1894
Hospital Charge Code	270662366C
Hospital Revenue Code	272
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$51.45
Rate for Payer: Aetna Commercial	$30.87
Rate for Payer: Aetna Medicare Advantage	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Commercial	$51.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.38
Rate for Payer: Oxford Commercial	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.44
Rate for Payer: UnitedHealthcare Commercial	$51.45

SUPERSHEATH INTRO WO GWIRE 12F

Facility

$102.90

Service Code	HCPCS C1894
Hospital Charge Code	270662366C
Hospital Revenue Code	272
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$15.44
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

SUPER TURBOVAC W FINGER SWITCH

Facility

$2,185.00

Hospital Charge Code	270652890
Hospital Revenue Code	272
Min. Negotiated Rate	$327.75
Max. Negotiated Rate	$327.75
Rate for Payer: Qualcare PPO/HMO/WC	$327.75

SUPER TURBOVAC W FINGER SWITCH

Facility

$2,185.00

Hospital Charge Code	270652890
Hospital Revenue Code	272
Min. Negotiated Rate	$284.05
Max. Negotiated Rate	$1,092.50
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare Advantage	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.17
Rate for Payer: Cigna Commercial	$1,092.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.05
Rate for Payer: Oxford Commercial	$1,092.50
Rate for Payer: Qualcare PPO/HMO/WC	$327.75
Rate for Payer: UnitedHealthcare Commercial	$1,092.50

SUPPORTA-LINE STANDARD

Facility

$13.33

Hospital Charge Code	270667643
Hospital Revenue Code	270
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.73
Rate for Payer: Oxford Commercial	$6.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$6.67

SUPPORTA-LINE STANDARD

Facility

$13.33

Hospital Charge Code	270667643
Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

SUPPORT ALM DLX ARTERIO 95985

Facility

$30.45

Hospital Charge Code	270617244
Hospital Revenue Code	272
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna Commercial	$9.13
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$15.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.57
Rate for Payer: UnitedHealthcare Commercial	$15.22

Know your out-of-pocket cost for care.

All Charges