Heights University Hospital

All Charges

Charge

Type

Setting

Price

SALICYLIC ACID 2% SHAMPOO

Facility

$74.45

Hospital Charge Code	60628435
Hospital Revenue Code	250
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$22.34
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$37.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Oxford Commercial	$37.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.17
Rate for Payer: UnitedHealthcare Commercial	$37.23

SALICYLIC ACID 2% SHAMPOO

Facility

$74.45

Hospital Charge Code	60628435
Hospital Revenue Code	250
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.17

SALINE 9 UNIT DOSE 15 ML

Facility

$0.82

Hospital Charge Code	270632373
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna Commercial	$0.25
Rate for Payer: Aetna Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.21
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.11
Rate for Payer: Oxford Commercial	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.12
Rate for Payer: UnitedHealthcare Commercial	$0.41

SALINE 9 UNIT DOSE 15 ML

Facility

$0.82

Hospital Charge Code	270632373
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.12

SALINE BAGS VITEK XL

Facility

$36.95

Hospital Charge Code	270667524
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$18.48
Rate for Payer: Aetna Commercial	$11.09
Rate for Payer: Aetna Medicare Advantage	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.42
Rate for Payer: Cigna Commercial	$18.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$18.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Commercial	$18.48

SALINE BAGS VITEK XL

Facility

$36.95

Hospital Charge Code	270667524
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

SALIVARY GLAND PROCEDURES

Facility

$47,689.32

Service Code	MSDRG 139
Min. Negotiated Rate	$13,484.68
Max. Negotiated Rate	$47,689.32
Rate for Payer: Aetna Commercial	$41,667.66
Rate for Payer: Aetna Medicare Advantage	$13,484.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32,804.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32,804.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,896.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32,804.73
Rate for Payer: Cigna Commercial	$26,010.28
Rate for Payer: Cigna Medicare Advantage	$15,896.44
Rate for Payer: Clover Medicare Advantage	$15,101.62
Rate for Payer: EmblemHealth Commercial	$47,689.32
Rate for Payer: Humana Medicare Advantage	$16,373.33
Rate for Payer: Oxford Commercial	$16,255.67
Rate for Payer: UnitedHealthcare Commercial	$18,451.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,896.44
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16,850.23
Rate for Payer: Wellcare Medicare Advantage	$15,896.44

SALIVA SUBSTITUTE/120ML

Facility

$90.45

Service Code	NDC 50930009808
Hospital Charge Code	60634632
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$45.23
Rate for Payer: Aetna Commercial	$27.14
Rate for Payer: Aetna Medicare Advantage	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.06
Rate for Payer: Cigna Commercial	$45.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.76
Rate for Payer: Oxford Commercial	$45.23
Rate for Payer: Qualcare PPO/HMO/WC	$13.57
Rate for Payer: UnitedHealthcare Commercial	$45.23

SALIVA SUBSTITUTE/120ML

Facility

$90.45

Service Code	NDC 50930009808
Hospital Charge Code	60634632
Hospital Revenue Code	250
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$13.57
Rate for Payer: Qualcare PPO/HMO/WC	$13.57

SALIVA SUBSTITUTES - ORAL SOLN

Facility

$46.45

Hospital Charge Code	60628455
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

SALIVA SUBSTITUTES - ORAL SOLN

Facility

$46.45

Hospital Charge Code	60628455
Hospital Revenue Code	250
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$13.94
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$23.23

SALIVA SUBSTITUTION COMBO

Facility

$23.86

Hospital Charge Code	606350909
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$11.93
Rate for Payer: Aetna Commercial	$7.16
Rate for Payer: Aetna Medicare Advantage	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.08
Rate for Payer: Cigna Commercial	$11.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.10
Rate for Payer: Oxford Commercial	$11.93
Rate for Payer: Qualcare PPO/HMO/WC	$3.58
Rate for Payer: UnitedHealthcare Commercial	$11.93

SALIVA SUBSTITUTION COMBO

Facility

$23.86

Hospital Charge Code	606350909
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.58

SALMETEROL 21MCG AEROSOL

Facility

$270.75

Hospital Charge Code	60627469
Hospital Revenue Code	252
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$135.38
Rate for Payer: Aetna Commercial	$81.22
Rate for Payer: Aetna Medicare Advantage	$81.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.04
Rate for Payer: Cigna Commercial	$135.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.20
Rate for Payer: Oxford Commercial	$135.38
Rate for Payer: Qualcare PPO/HMO/WC	$40.61
Rate for Payer: UnitedHealthcare Commercial	$135.38

SALMETEROL 21MCG AEROSOL

Facility

$270.75

Hospital Charge Code	60627469
Hospital Revenue Code	252
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$40.61
Rate for Payer: Qualcare PPO/HMO/WC	$40.61

SALMETEROL INHALER

Facility

$336.00

Hospital Charge Code	6016471
Hospital Revenue Code	252
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$100.80
Rate for Payer: Aetna Medicare Advantage	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.68
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.68
Rate for Payer: Oxford Commercial	$168.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$168.00

SALMETEROL INHALER

Facility

$336.00

Hospital Charge Code	6016471
Hospital Revenue Code	252
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

SALMONELLA AB I

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
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	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

SALMONELLA AB I

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB II

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB II

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149B
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
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	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

SALMONELLA AB III

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149C
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
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	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

SALMONELLA AB III

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB IV

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149D
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
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	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

SALMONELLA AB IV

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149D
Hospital Revenue Code	302
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