Heights University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 2.5 MEQ/5 ML VIAL

Facility

$20.50

Service Code	NDC 63323002605
Hospital Charge Code	6063943242
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.08

SODIUM BICARBONATE/650MG

Facility

$1.00

Hospital Charge Code	60633903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SODIUM BICARBONATE/650MG

Facility

$1.00

Hospital Charge Code	60633903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

SODIUM BICARBONATE 650 MG TAB

Facility

$4.00

Service Code	NDC 64980018210
Hospital Charge Code	60628112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM BICARBONATE 650 MG TAB

Facility

$4.00

Service Code	NDC 64980018210
Hospital Charge Code	60628112
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

SODIUM BICARBONATE 7.5%/4

Facility

$32.00

Hospital Charge Code	60633904
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

SODIUM BICARBONATE 7.5%/4

Facility

$32.00

Hospital Charge Code	60633904
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SODIUM BICARBONATE 7.5% 50ML S

Facility

$97.15

Service Code	NDC 409491634
Hospital Charge Code	6063943243
Hospital Revenue Code	250
Min. Negotiated Rate	$12.63
Max. Negotiated Rate	$48.58
Rate for Payer: Aetna Commercial	$29.14
Rate for Payer: Aetna Medicare Advantage	$29.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.77
Rate for Payer: Cigna Commercial	$48.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.63
Rate for Payer: Oxford Commercial	$48.58
Rate for Payer: Qualcare PPO/HMO/WC	$14.57
Rate for Payer: UnitedHealthcare Commercial	$48.58

SODIUM BICARBONATE 7.5% 50ML S

Facility

$97.15

Service Code	NDC 409491634
Hospital Charge Code	6063943243
Hospital Revenue Code	250
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$14.57

SODIUM BICARBONATE (8.4%)

Facility

$4.42

Service Code	NDC 409662502
Hospital Charge Code	60627890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

SODIUM BICARBONATE (8.4%)

Facility

$4.42

Service Code	NDC 409662502
Hospital Charge Code	60627890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.57
Rate for Payer: Oxford Commercial	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$2.21

SODIUM BICARBONATE 8.4%

Facility

$142.00

Hospital Charge Code	60635716
Hospital Revenue Code	250
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

SODIUM BICARBONATE 8.4%

Facility

$142.00

Hospital Charge Code	60635716
Hospital Revenue Code	250
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$42.60
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$71.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$71.00

SODIUM BICARBONATE 8.4%(PED) S

Facility

$88.91

Service Code	NDC 409490034
Hospital Charge Code	6063943244
Hospital Revenue Code	250
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$44.45
Rate for Payer: Aetna Commercial	$26.67
Rate for Payer: Aetna Medicare Advantage	$26.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.67
Rate for Payer: Cigna Commercial	$44.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.56
Rate for Payer: Oxford Commercial	$44.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.34
Rate for Payer: UnitedHealthcare Commercial	$44.45

SODIUM BICARBONATE 8.4%(PED) S

Facility

$88.91

Service Code	NDC 409490034
Hospital Charge Code	6063943244
Hospital Revenue Code	250
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$13.34
Rate for Payer: Qualcare PPO/HMO/WC	$13.34

SODIUM BICARBONATE 8.4% SOLN

Facility

$26.50

Hospital Charge Code	60627887
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.98

SODIUM BICARBONATE 8.4% SOLN

Facility

$26.50

Hospital Charge Code	60627887
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$13.25
Rate for Payer: Aetna Commercial	$7.95
Rate for Payer: Aetna Medicare Advantage	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.76
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.44
Rate for Payer: Oxford Commercial	$13.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.98
Rate for Payer: UnitedHealthcare Commercial	$13.25

SODIUM BICARB POWD 100% 120G

Facility

$10.90

Hospital Charge Code	60629061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

SODIUM BICARB POWD 100% 120G

Facility

$10.90

Hospital Charge Code	60629061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

SODIUM BICARB SYRG 50MEQ

Facility

$54.27

Service Code	NDC 76329335201
Hospital Charge Code	60627888
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$27.14
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Aetna Medicare Advantage	$16.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.84
Rate for Payer: Cigna Commercial	$27.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.06
Rate for Payer: Oxford Commercial	$27.14
Rate for Payer: Qualcare PPO/HMO/WC	$8.14
Rate for Payer: UnitedHealthcare Commercial	$27.14

SODIUM BICARB SYRG 50MEQ

Facility

$54.27

Service Code	NDC 76329335201
Hospital Charge Code	60627888
Hospital Revenue Code	250
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$8.14
Rate for Payer: Qualcare PPO/HMO/WC	$8.14

SODIUM BICARB VL 4% 5ML

Facility

$10.45

Hospital Charge Code	6017693
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

SODIUM BICARB VL 4% 5ML

Facility

$10.45

Hospital Charge Code	6017693
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

SODIUMCHLOR 0.9% IRRIG 1000ml

Facility

$22.50

Hospital Charge Code	270649320
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$6.75
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$11.25

SODIUMCHLOR 0.9% IRRIG 1000ml

Facility

$22.50

Hospital Charge Code	270649320
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

Know your out-of-pocket cost for care.

All Charges