Heights University Hospital

All Charges

Charge

Type

Setting

Price

SILVER SOAKER CATH PM020-A

Facility

$295.00

Hospital Charge Code	270657264
Hospital Revenue Code	272
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$147.50
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$147.50

SILVER SOAKER CATH PM020-A

Facility

$295.00

Hospital Charge Code	270657264
Hospital Revenue Code	272
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

SILVER SULFAD CRM 1% 20GM

Facility

$25.60

Hospital Charge Code	6004881
Hospital Revenue Code	251
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

SILVER SULFAD CRM 1% 20GM

Facility

$25.60

Hospital Charge Code	6004881
Hospital Revenue Code	251
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

SILVER SULFAD CRM 1% 400GM

Facility

$113.30

Hospital Charge Code	6004907
Hospital Revenue Code	251
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

SILVER SULFAD CRM 1% 400GM

Facility

$113.30

Hospital Charge Code	6004907
Hospital Revenue Code	251
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$33.99
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$56.65
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$56.65

SILVER SULFAD CRM 1% 400GM

Facility

$4.00

Service Code	NDC 591081046
Hospital Charge Code	60628364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SILVER SULFAD CRM 1% 400GM

Facility

$4.00

Service Code	NDC 591081046
Hospital Charge Code	60628364
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

SILVER SULFAD CRM 1% 50GM

Facility

$61.45

Hospital Charge Code	6004899
Hospital Revenue Code	251
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

SILVER SULFAD CRM 1% 50GM

Facility

$61.45

Hospital Charge Code	6004899
Hospital Revenue Code	251
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

SILVER SULFADIAZINE 20 GM CRE

Facility

$17.69

Service Code	NDC 61570013150
Hospital Charge Code	60628363
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

SILVER SULFADIAZINE 20 GM CRE

Facility

$17.69

Service Code	NDC 61570013150
Hospital Charge Code	60628363
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$5.31
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.30
Rate for Payer: Oxford Commercial	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$8.85

SILVER SULFADIAZINE 50 GM CRE

Facility

$311.22

Service Code	NDC 49999014350
Hospital Charge Code	60628365
Hospital Revenue Code	250
Min. Negotiated Rate	$40.46
Max. Negotiated Rate	$155.61
Rate for Payer: Aetna Commercial	$93.37
Rate for Payer: Aetna Medicare Advantage	$93.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.36
Rate for Payer: Cigna Commercial	$155.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.46
Rate for Payer: Oxford Commercial	$155.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.68
Rate for Payer: UnitedHealthcare Commercial	$155.61

SILVER SULFADIAZINE 50 GM CRE

Facility

$311.22

Service Code	NDC 49999014350
Hospital Charge Code	60628365
Hospital Revenue Code	250
Min. Negotiated Rate	$46.68
Max. Negotiated Rate	$46.68
Rate for Payer: Qualcare PPO/HMO/WC	$46.68

S&I LV GRAM

Facility

$2,167.25

Hospital Charge Code	5100169
Hospital Revenue Code	481
Min. Negotiated Rate	$281.74
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$650.17
Rate for Payer: Aetna Medicare Advantage	$650.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.65
Rate for Payer: Cigna Commercial	$1,083.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.74
Rate for Payer: Qualcare PPO/HMO/WC	$325.09

S&I LV GRAM

Facility

$2,167.25

Hospital Charge Code	5100169
Hospital Revenue Code	481
Min. Negotiated Rate	$325.09
Max. Negotiated Rate	$325.09
Rate for Payer: Qualcare PPO/HMO/WC	$325.09

S&I LV GRAM

Facility

$2,167.25

Hospital Charge Code	74110018
Hospital Revenue Code	481
Min. Negotiated Rate	$325.09
Max. Negotiated Rate	$325.09
Rate for Payer: Qualcare PPO/HMO/WC	$325.09

S&I LV GRAM

Facility

$2,167.25

Hospital Charge Code	74110018
Hospital Revenue Code	481
Min. Negotiated Rate	$281.74
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$650.17
Rate for Payer: Aetna Medicare Advantage	$650.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.65
Rate for Payer: Cigna Commercial	$1,083.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.74
Rate for Payer: Qualcare PPO/HMO/WC	$325.09

SILVR SULFADIAZIN 1% CRM 25 GM

Facility

$90.79

Service Code	NDC 67877012425
Hospital Charge Code	606390116
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$45.40
Rate for Payer: Aetna Commercial	$27.24
Rate for Payer: Aetna Medicare Advantage	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.15
Rate for Payer: Cigna Commercial	$45.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Oxford Commercial	$45.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.62
Rate for Payer: UnitedHealthcare Commercial	$45.40

SILVR SULFADIAZIN 1% CRM 25 GM

Facility

$90.79

Service Code	NDC 67877012425
Hospital Charge Code	606390116
Hospital Revenue Code	250
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$13.62

SIMETHICONE 125 MG CHE

Facility

$4.00

Service Code	NDC 536453408
Hospital Charge Code	60628122
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SIMETHICONE 125 MG CHE

Facility

$4.00

Service Code	NDC 536453408
Hospital Charge Code	60628122
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

SIMETHICONE 80 MG CHE

Facility

$4.00

Service Code	NDC 63739022510
Hospital Charge Code	60628121
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

SIMETHICONE 80 MG CHE

Facility

$4.00

Service Code	NDC 63739022510
Hospital Charge Code	60628121
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SIMETHICONE LQ 40MG/.6ML 30ML

Facility

$4.00

Service Code	NDC 536222075
Hospital Charge Code	6004915
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges