Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUPRAFOIL SMOOTH NYLON 4CMX4CM

Facility

$38.75

Hospital Charge Code	270640738
Hospital Revenue Code	270
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$19.38
Rate for Payer: Aetna Commercial	$11.62
Rate for Payer: Aetna Medicare Advantage	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.88
Rate for Payer: Cigna Commercial	$19.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.04
Rate for Payer: Oxford Commercial	$19.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.81
Rate for Payer: UnitedHealthcare Commercial	$19.38

SUPRAFOIL SMOOTH NYLON 4CMX4CM

Facility

$38.75

Hospital Charge Code	270640738
Hospital Revenue Code	270
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$5.81
Rate for Payer: Qualcare PPO/HMO/WC	$5.81

SUPRAX/100MG/5ML 100ML

Facility

$276.00

Hospital Charge Code	60634912
Hospital Revenue Code	250
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$82.80
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$138.00

SUPRAX/100MG/5ML 100ML

Facility

$276.00

Hospital Charge Code	60634912
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

SUPRAX/400MG/CAP

Facility

$28.00

Hospital Charge Code	60634914
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

SUPRAX/400MG/CAP

Facility

$28.00

Hospital Charge Code	60634914
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

SUPVJ HANDLING LOADING

Facility

$200.00

Service Code	HCPCS 77790
Hospital Charge Code	85000880
Hospital Revenue Code	342
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SUPVJ HANDLING LOADING

Facility

$200.00

Service Code	HCPCS 77790
Hospital Charge Code	85000880
Hospital Revenue Code	342
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$21.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

SUR CD NEXGEN LPSFLEXFIXED 3-4

Facility

$5,862.10

Hospital Charge Code	270663479
Hospital Revenue Code	270
Min. Negotiated Rate	$762.07
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.07
Rate for Payer: Oxford Commercial	$2,931.05
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Commercial	$2,931.05

SUR CD NEXGEN LPSFLEXFIXED 3-4

Facility

$5,862.10

Hospital Charge Code	270663479
Hospital Revenue Code	270
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$879.32
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

SURE CLOSURE SYSTEM *********

Facility

$1,308.00

Hospital Charge Code	1605807
Hospital Revenue Code	272
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$196.20
Rate for Payer: Qualcare PPO/HMO/WC	$196.20

SURE CLOSURE SYSTEM *********

Facility

$1,308.00

Hospital Charge Code	1605807
Hospital Revenue Code	272
Min. Negotiated Rate	$170.04
Max. Negotiated Rate	$654.00
Rate for Payer: Aetna Commercial	$392.40
Rate for Payer: Aetna Medicare Advantage	$392.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$333.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$333.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$333.54
Rate for Payer: Cigna Commercial	$654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.04
Rate for Payer: Oxford Commercial	$654.00
Rate for Payer: Qualcare PPO/HMO/WC	$196.20
Rate for Payer: UnitedHealthcare Commercial	$654.00

SUREPATH-FPGS/HPV RFX GENOTYPE

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900408
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

SUREPATH-FPGS/HPV RFX GENOTYPE

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900408
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

SUREPATH W/FOCAL POINT RE

Facility

$176.15

Service Code	HCPCS 88175
Hospital Charge Code	39900312
Hospital Revenue Code	311
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.42
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

SUREPATH W/FOCAL POINT RE

Facility

$176.15

Service Code	HCPCS 88175
Hospital Charge Code	39900312
Hospital Revenue Code	311
Min. Negotiated Rate	$26.42
Max. Negotiated Rate	$26.42
Rate for Payer: Qualcare PPO/HMO/WC	$26.42

SURE SWAB I

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113A
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURE SWAB I

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB II

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB II

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113B
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURE SWAB III

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113C
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURE SWAB III

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113C
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB IV

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113D
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB IV

Facility

$390.00

Service Code	HCPCS 8748191
Hospital Charge Code	39990113D
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURE SWAB IX

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113I
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges