Heights University Hospital

All Charges

Charge

Type

Setting

Price

SYMBOTEX COMPOSIT MESH 30 X 20

Facility

$9,144.05

Service Code	HCPCS C1781
Hospital Charge Code	270678857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,371.61
Max. Negotiated Rate	$2,212.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,828.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.61

SYMBOTEX COMPOSIT MESH 37 BY 2

Facility

$10,701.90

Service Code	HCPCS C1781
Hospital Charge Code	270678858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.29
Max. Negotiated Rate	$5,350.95
Rate for Payer: Aetna Commercial	$3,210.57
Rate for Payer: Aetna Medicare Advantage	$3,210.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,728.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,728.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,140.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,728.98
Rate for Payer: Cigna Commercial	$5,350.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.29

SYMBOTEX COMPOSIT MESH 37 BY 2

Facility

$10,701.90

Service Code	HCPCS C1781
Hospital Charge Code	270678858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.29
Max. Negotiated Rate	$2,589.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,140.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.29

SYMBOTEX COMPOSIT MESH 42 X 32

Facility

$12,844.10

Service Code	HCPCS C1781
Hospital Charge Code	270678859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,926.62
Max. Negotiated Rate	$6,422.05
Rate for Payer: Aetna Commercial	$3,853.23
Rate for Payer: Aetna Medicare Advantage	$3,853.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,275.25
Rate for Payer: Cigna Commercial	$6,422.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,108.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.62

SYMBOTEX COMPOSIT MESH 42 X 32

Facility

$12,844.10

Service Code	HCPCS C1781
Hospital Charge Code	270678859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,926.62
Max. Negotiated Rate	$3,108.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,108.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.62

SYMMETREL/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633942
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYMMETREL/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633942
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

SYMMETREL LIQUID/16OZ

Facility

$4.00

Service Code	NDC 121064616
Hospital Charge Code	60634589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SYMMETREL LIQUID/16OZ

Facility

$4.00

Service Code	NDC 121064616
Hospital Charge Code	60634589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SYMPHONY GRAFT DELIVERY SYS

Facility

$1,050.00

Hospital Charge Code	270657922
Hospital Revenue Code	272
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

SYMPHONY GRAFT DELIVERY SYS

Facility

$1,050.00

Hospital Charge Code	270657922
Hospital Revenue Code	272
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$525.00

SYNALAR 0.1% CREAM/15GM

Facility

$298.62

Service Code	NDC 168005815
Hospital Charge Code	60634441
Hospital Revenue Code	250
Min. Negotiated Rate	$38.82
Max. Negotiated Rate	$149.31
Rate for Payer: Aetna Commercial	$89.59
Rate for Payer: Aetna Medicare Advantage	$89.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.15
Rate for Payer: Cigna Commercial	$149.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.82
Rate for Payer: Oxford Commercial	$149.31
Rate for Payer: Qualcare PPO/HMO/WC	$44.79
Rate for Payer: UnitedHealthcare Commercial	$149.31

SYNALAR 0.1% CREAM/15GM

Facility

$298.62

Service Code	NDC 168005815
Hospital Charge Code	60634441
Hospital Revenue Code	250
Min. Negotiated Rate	$44.79
Max. Negotiated Rate	$44.79
Rate for Payer: Qualcare PPO/HMO/WC	$44.79

SYNALAR .025% CREAM/15GM

Facility

$71.00

Hospital Charge Code	60634442
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

SYNALAR .025% CREAM/15GM

Facility

$71.00

Hospital Charge Code	60634442
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

SYNALAR OINTMENT/15GM

Facility

$226.26

Service Code	NDC 168006415
Hospital Charge Code	60634443
Hospital Revenue Code	250
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$113.13
Rate for Payer: Aetna Commercial	$67.88
Rate for Payer: Aetna Medicare Advantage	$67.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.70
Rate for Payer: Cigna Commercial	$113.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.41
Rate for Payer: Oxford Commercial	$113.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.94
Rate for Payer: UnitedHealthcare Commercial	$113.13

SYNALAR OINTMENT/15GM

Facility

$226.26

Service Code	NDC 168006415
Hospital Charge Code	60634443
Hospital Revenue Code	250
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Qualcare PPO/HMO/WC	$33.94

SYNCHFIX EVT SYNDESMOSIS #5 SU

Facility

$13,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705891
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

SYNCHFIX EVT SYNDESMOSIS #5 SU

Facility

$13,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705891
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$4,125.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

Synchro 200cm soft

Facility

$3,000.00

Hospital Charge Code	270685069N
Hospital Revenue Code	272
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Synchro 200cm soft

Facility

$3,000.00

Hospital Charge Code	270685069N
Hospital Revenue Code	272
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$1,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$1,500.00

Synchro 300cm soft

Facility

$3,750.00

Hospital Charge Code	270685070N
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$1,875.00

Synchro 300cm soft

Facility

$3,750.00

Hospital Charge Code	270685070N
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Synchro 300cm Stand

Facility

$3,750.00

Hospital Charge Code	270685071N
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Synchro 300cm Stand

Facility

$3,750.00

Hospital Charge Code	270685071N
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$1,875.00

Know your out-of-pocket cost for care.

All Charges