Heights University Hospital

All Charges

Charge

Type

Setting

Price

SYPHILIS AB CASCADE REFL

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39900257
Hospital Revenue Code	302
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.51
Rate for Payer: Cigna Commercial	$13.24
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.03
Rate for Payer: Wellcare Medicare Advantage	$13.24

SYPHILIS AB CASCADE REFL

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39900257
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

SYR BASIX COMP W/MAP112 IN4230

Facility

$250.00

Hospital Charge Code	270637374
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

SYR BASIX COMP W/MAP112 IN4230

Facility

$250.00

Hospital Charge Code	270637374
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$364.50
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825S
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825S
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$364.50
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYRGE BASX CMPK INFLTN IN4130

Facility

$130.70

Hospital Charge Code	270636814C
Hospital Revenue Code	272
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$65.35
Rate for Payer: Aetna Commercial	$39.21
Rate for Payer: Aetna Medicare Advantage	$39.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.33
Rate for Payer: Cigna Commercial	$65.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.99
Rate for Payer: Oxford Commercial	$65.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.61
Rate for Payer: UnitedHealthcare Commercial	$65.35

SYRGE BASX CMPK INFLTN IN4130

Facility

$130.70

Hospital Charge Code	270636814C
Hospital Revenue Code	272
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$19.61

SYRINGE 10cc W/LUER LOCK

Facility

$0.35

Hospital Charge Code	27020080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna Commercial	$0.11
Rate for Payer: Aetna Medicare Advantage	$0.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.09
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.05
Rate for Payer: Oxford Commercial	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.18

SYRINGE 10cc W/LUER LOCK

Facility

$0.35

Hospital Charge Code	27020080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

SYRINGE 10CC W/LUER LOK 309604

Facility

$0.35

Hospital Charge Code	270309604C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

SYRINGE 10CC W/LUER LOK 309604

Facility

$0.35

Hospital Charge Code	270309604C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna Commercial	$0.11
Rate for Payer: Aetna Medicare Advantage	$0.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.09
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.05
Rate for Payer: Oxford Commercial	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.18

SYRINGE 10ML W LUER LOCK

Facility

$213.90

Hospital Charge Code	270020080
Hospital Revenue Code	272
Min. Negotiated Rate	$27.81
Max. Negotiated Rate	$106.95
Rate for Payer: Aetna Commercial	$64.17
Rate for Payer: Aetna Medicare Advantage	$64.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.54
Rate for Payer: Cigna Commercial	$106.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.81
Rate for Payer: Oxford Commercial	$106.95
Rate for Payer: Qualcare PPO/HMO/WC	$32.09
Rate for Payer: UnitedHealthcare Commercial	$106.95

SYRINGE 10ML W LUER LOCK

Facility

$213.90

Hospital Charge Code	270020080
Hospital Revenue Code	272
Min. Negotiated Rate	$32.09
Max. Negotiated Rate	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$32.09

SYRINGE 1ml DURASPE EXP 890215

Facility

$982.15

Hospital Charge Code	270632488
Hospital Revenue Code	272
Min. Negotiated Rate	$127.68
Max. Negotiated Rate	$491.07
Rate for Payer: Aetna Commercial	$294.64
Rate for Payer: Aetna Medicare Advantage	$294.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.45
Rate for Payer: Cigna Commercial	$491.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.68
Rate for Payer: Oxford Commercial	$491.07
Rate for Payer: Qualcare PPO/HMO/WC	$147.32
Rate for Payer: UnitedHealthcare Commercial	$491.07

SYRINGE 1ml DURASPE EXP 890215

Facility

$982.15

Hospital Charge Code	270632488
Hospital Revenue Code	272
Min. Negotiated Rate	$147.32
Max. Negotiated Rate	$147.32
Rate for Payer: Qualcare PPO/HMO/WC	$147.32

SYRINGE 20CC BF301625

Facility

$80.00

Hospital Charge Code	270606347
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

SYRINGE 20CC BF301625

Facility

$80.00

Hospital Charge Code	270606347
Hospital Revenue Code	272
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

SYRINGE 20cc W/LUER LOK

Facility

$0.93

Hospital Charge Code	27020090
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna Commercial	$0.28
Rate for Payer: Aetna Medicare Advantage	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.24
Rate for Payer: Cigna Commercial	$0.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.12
Rate for Payer: Oxford Commercial	$0.47
Rate for Payer: Qualcare PPO/HMO/WC	$0.14
Rate for Payer: UnitedHealthcare Commercial	$0.47

SYRINGE 20cc W/LUER LOK

Facility

$0.93

Hospital Charge Code	27020090
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.14

SYRINGE 20CC W/LUER LOK 309661

Facility

$0.35

Hospital Charge Code	270309661C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna Commercial	$0.11
Rate for Payer: Aetna Medicare Advantage	$0.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.09
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.05
Rate for Payer: Oxford Commercial	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.18

SYRINGE 20CC W/LUER LOK 309661

Facility

$0.35

Hospital Charge Code	270309661C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

SYRINGE 30CC W/LUER LOCK

Facility

$1.05

Hospital Charge Code	270020095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.32
Rate for Payer: Aetna Medicare Advantage	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.27
Rate for Payer: Cigna Commercial	$0.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.14
Rate for Payer: Oxford Commercial	$0.53
Rate for Payer: Qualcare PPO/HMO/WC	$0.16
Rate for Payer: UnitedHealthcare Commercial	$0.53

Know your out-of-pocket cost for care.

All Charges