Heights University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 0.9% 500 ML

Facility

$15.68

Service Code	NDC 264780010
Hospital Charge Code	60627915
Hospital Revenue Code	258
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.35

SODIUM CHLORIDE 0.9% 50 ML

Facility

$17.09

Service Code	NDC 990798413
Hospital Charge Code	60627916
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.56

SODIUM CHLORIDE 0.9% 50 ML

Facility

$17.09

Service Code	NDC 990798413
Hospital Charge Code	60627916
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$8.54
Rate for Payer: Aetna Commercial	$5.13
Rate for Payer: Aetna Medicare Advantage	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.36
Rate for Payer: Cigna Commercial	$8.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.22
Rate for Payer: Oxford Commercial	$8.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.56
Rate for Payer: UnitedHealthcare Commercial	$8.54

SODIUM CHLORIDE 0.9% BACT

Facility

$7.00

Hospital Charge Code	60633905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

SODIUM CHLORIDE 0.9% BACT

Facility

$7.00

Hospital Charge Code	60633905
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SODIUM CHLORIDE 0.9% IRRIG

Facility

$62.91

Service Code	NDC 990797208
Hospital Charge Code	606361020
Hospital Revenue Code	272
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$9.44
Rate for Payer: Qualcare PPO/HMO/WC	$9.44

SODIUM CHLORIDE 0.9% IRRIG

Facility

$62.91

Service Code	NDC 990797208
Hospital Charge Code	606361020
Hospital Revenue Code	272
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$31.45
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna Medicare Advantage	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.04
Rate for Payer: Cigna Commercial	$31.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$31.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.44
Rate for Payer: UnitedHealthcare Commercial	$31.45

SODIUM CHLORIDE 0.9% IRRIG SOLN

Facility

$42.21

Service Code	NDC 990713809
Hospital Charge Code	6063943245
Hospital Revenue Code	272
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

SODIUM CHLORIDE 0.9% IRRIG SOLN

Facility

$42.21

Service Code	NDC 990713809
Hospital Charge Code	6063943245
Hospital Revenue Code	272
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$21.11
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna Medicare Advantage	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.76
Rate for Payer: Cigna Commercial	$21.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.49
Rate for Payer: Oxford Commercial	$21.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.33
Rate for Payer: UnitedHealthcare Commercial	$21.11

SODIUM CHLORIDE 14.6%/2.5

Facility

$18.00

Hospital Charge Code	60633906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

SODIUM CHLORIDE 14.6%/2.5

Facility

$18.00

Hospital Charge Code	60633906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SODIUM CHLORIDE/1GM/TAB

Facility

$1.00

Hospital Charge Code	60634214
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 CHLORIDE/1GM/TAB

Facility

$1.00

Hospital Charge Code	60634214
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SODIUM CHLORIDE 20MLINJ

Facility

$2.00

Hospital Charge Code	60635609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

SODIUM CHLORIDE 20MLINJ

Facility

$2.00

Hospital Charge Code	60635609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

SODIUM CHLORIDE 23.4%/4ME

Facility

$17.00

Hospital Charge Code	60633907
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.50

SODIUM CHLORIDE 23.4%/4ME

Facility

$17.00

Hospital Charge Code	60633907
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

SODIUM CHLORIDE 3%

Facility

$8.00

Hospital Charge Code	60635409
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

SODIUM CHLORIDE 3%

Facility

$8.00

Hospital Charge Code	60635409
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

SODIUM CHLORIDE 3% HYPERTONIC

Facility

$33.50

Service Code	NDC 264780510
Hospital Charge Code	60628857
Hospital Revenue Code	258
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

SODIUM CHLORIDE 3% HYPERTONIC

Facility

$33.50

Service Code	NDC 264780510
Hospital Charge Code	60628857
Hospital Revenue Code	258
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$16.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$16.75

SODIUM CHLORIDE 3% INH SOL 4ML

Facility

$4.00

Service Code	NDC 487900360
Hospital Charge Code	606390070
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 CHLORIDE 3% INH SOL 4ML

Facility

$4.00

Service Code	NDC 487900360
Hospital Charge Code	606390070
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM CHLORIDE 45 ML

Facility

$31.56

Service Code	NDC 187526001
Hospital Charge Code	6004980
Hospital Revenue Code	251
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Qualcare PPO/HMO/WC	$4.73

SODIUM CHLORIDE 45 ML

Facility

$31.56

Service Code	NDC 187526001
Hospital Charge Code	6004980
Hospital Revenue Code	251
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$15.78
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.05
Rate for Payer: Cigna Commercial	$15.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.10
Rate for Payer: Oxford Commercial	$15.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.73
Rate for Payer: UnitedHealthcare Commercial	$15.78

Know your out-of-pocket cost for care.

All Charges