Heights University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 50ML MNBG

Facility

$64.00

Hospital Charge Code	60635684
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

SODIUM CHLORIDE 50ML MNBG

Facility

$64.00

Hospital Charge Code	60635684
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

SODIUM CHLORIDE DROPS 0.65%

Facility

$10.00

Hospital Charge Code	60629275
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

SODIUM CHLORIDE DROPS 0.65%

Facility

$10.00

Hospital Charge Code	60629275
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

SODIUM CHLORIDE DROPS 0.6570

Facility

$8.00

Hospital Charge Code	60624275
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 DROPS 0.6570

Facility

$8.00

Hospital Charge Code	60624275
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 CHLOR INJ 0.9% 10ML

Facility

$9.25

Service Code	NDC 409108151
Hospital Charge Code	60627917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

SODIUM CHLOR INJ 0.9% 10ML

Facility

$9.25

Service Code	NDC 409108151
Hospital Charge Code	60627917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.62
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$4.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$4.62

SODIUM CHLOR INJ 0.9% BL PT

Facility

$9.00

Hospital Charge Code	60627934
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

SODIUM CHLOR INJ 0.9% BL PT

Facility

$9.00

Hospital Charge Code	60627934
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

SODIUM CHLOR OINT OPH 5% 3.5GM

Facility

$64.00

Hospital Charge Code	6004964
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

SODIUM CHLOR OINT OPH 5% 3.5GM

Facility

$64.00

Hospital Charge Code	6004964
Hospital Revenue Code	251
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

SODIUM CHLOR (ORANGE)

Facility

$1.95

Hospital Charge Code	6022826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

SODIUM CHLOR (ORANGE)

Facility

$1.95

Hospital Charge Code	6022826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

SODIUM CHLOR SOL 0.9% IRRIG

Facility

$98.09

Service Code	NDC 338004747
Hospital Charge Code	60629145
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$49.05
Rate for Payer: Aetna Commercial	$29.43
Rate for Payer: Aetna Medicare Advantage	$29.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.01
Rate for Payer: Cigna Commercial	$49.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.75
Rate for Payer: Oxford Commercial	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.71
Rate for Payer: UnitedHealthcare Commercial	$49.05

SODIUM CHLOR SOL 0.9% IRRIG

Facility

$98.09

Service Code	NDC 338004747
Hospital Charge Code	60629145
Hospital Revenue Code	272
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$14.71
Rate for Payer: Qualcare PPO/HMO/WC	$14.71

SODIUM CHLOR SOL FOR INH

Facility

$10.50

Hospital Charge Code	60628100
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$3.15
Rate for Payer: Aetna Medicare Advantage	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.25

SODIUM CHLOR SOL FOR INH

Facility

$10.50

Hospital Charge Code	60628100
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

SODIUM CHLOR SOL OPH 5%

Facility

$102.00

Hospital Charge Code	60628099
Hospital Revenue Code	250
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Aetna Medicare Advantage	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.01
Rate for Payer: Cigna Commercial	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.26
Rate for Payer: Oxford Commercial	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.30
Rate for Payer: UnitedHealthcare Commercial	$51.00

SODIUM CHLOR SOL OPH 5%

Facility

$102.00

Hospital Charge Code	60628099
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$15.30

SODIUM CHLOR SOL OPH 5% 15ML

Facility

$64.00

Hospital Charge Code	6004972
Hospital Revenue Code	251
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

SODIUM CHLOR SOL OPH 5% 15ML

Facility

$64.00

Hospital Charge Code	6004972
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

SODIUM CHLOR TAB 1GM

Facility

$4.00

Service Code	NDC 223176001
Hospital Charge Code	6004998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM CHLOR TAB 1GM

Facility

$4.00

Service Code	NDC 223176001
Hospital Charge Code	6004998
Hospital Revenue Code	251
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 CHLOR TUBX 0.9%

Facility

$3.20

Hospital Charge Code	6013221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

Know your out-of-pocket cost for care.

All Charges