Heights University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLOR TUBX 0.9%

Facility

$3.20

Hospital Charge Code	6013221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

SODIUM CHLOR VL 0.9 10ML

Facility

$3.20

Hospital Charge Code	6022834
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

SODIUM CHLOR VL 0.9 10ML

Facility

$3.20

Hospital Charge Code	6022834
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

SODIUM CHLOR VL 30ML

Facility

$3.20

Hospital Charge Code	6022842
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

SODIUM CHLOR VL 30ML

Facility

$3.20

Hospital Charge Code	6022842
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

SODIUM CHRLORIDE 0.9% 3000 ML

Facility

$40.70

Hospital Charge Code	60630175
Hospital Revenue Code	250
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$6.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.11

SODIUM CHRLORIDE 0.9% 3000 ML

Facility

$40.70

Hospital Charge Code	60630175
Hospital Revenue Code	250
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$20.35
Rate for Payer: Aetna Commercial	$12.21
Rate for Payer: Aetna Medicare Advantage	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.38
Rate for Payer: Cigna Commercial	$20.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.29
Rate for Payer: Oxford Commercial	$20.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.11
Rate for Payer: UnitedHealthcare Commercial	$20.35

SODIUM CITRATE ACID SOL 15ML

Facility

$3.85

Hospital Charge Code	6025076
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

SODIUM CITRATE ACID SOL 15ML

Facility

$3.85

Hospital Charge Code	6025076
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

SODIUM CITRATE SOL

Facility

$4.85

Hospital Charge Code	60627891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

SODIUM CITRATE SOL

Facility

$4.85

Hospital Charge Code	60627891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

SODIUM CL 0.9% INH SOL 3 ML

Facility

$4.00

Service Code	NDC 487930103
Hospital Charge Code	60629119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM CL 0.9% INH SOL 3 ML

Facility

$4.00

Service Code	NDC 487930103
Hospital Charge Code	60629119
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,FECES

Facility

$33.45

Service Code	HCPCS 84302
Hospital Charge Code	39900133
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.02

SODIUM,FECES

Facility

$33.45

Service Code	HCPCS 84302
Hospital Charge Code	39900133
Hospital Revenue Code	301
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.81
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: Cigna Medicare Advantage	$2.43
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.15
Rate for Payer: Wellcare Medicare Advantage	$4.86

SODIUM HYALURONATE GV INJ

Facility

$765.00

Hospital Charge Code	6011001
Hospital Revenue Code	250
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

SODIUM HYALURONATE GV INJ

Facility

$765.00

Hospital Charge Code	6011001
Hospital Revenue Code	250
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.45
Rate for Payer: Oxford Commercial	$382.50
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$382.50

SODIUM HYALURONATE INJ OPH0.55

Facility

$563.00

Hospital Charge Code	6013213
Hospital Revenue Code	250
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$281.50
Rate for Payer: Aetna Commercial	$168.90
Rate for Payer: Aetna Medicare Advantage	$168.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.56
Rate for Payer: Cigna Commercial	$281.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.19
Rate for Payer: Oxford Commercial	$281.50
Rate for Payer: Qualcare PPO/HMO/WC	$84.45
Rate for Payer: UnitedHealthcare Commercial	$281.50

SODIUM HYALURONATE INJ OPH0.55

Facility

$563.00

Hospital Charge Code	6013213
Hospital Revenue Code	250
Min. Negotiated Rate	$84.45
Max. Negotiated Rate	$84.45
Rate for Payer: Qualcare PPO/HMO/WC	$84.45

SODIUM HYALURONATE OPH 10MG/ML

Facility

$1,897.50

Hospital Charge Code	60628101
Hospital Revenue Code	250
Min. Negotiated Rate	$246.68
Max. Negotiated Rate	$948.75
Rate for Payer: Aetna Commercial	$569.25
Rate for Payer: Aetna Medicare Advantage	$569.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.86
Rate for Payer: Cigna Commercial	$948.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.68
Rate for Payer: Oxford Commercial	$948.75
Rate for Payer: Qualcare PPO/HMO/WC	$284.62
Rate for Payer: UnitedHealthcare Commercial	$948.75

SODIUM HYALURONATE OPH 10MG/ML

Facility

$1,897.50

Hospital Charge Code	60628101
Hospital Revenue Code	250
Min. Negotiated Rate	$284.62
Max. Negotiated Rate	$284.62
Rate for Payer: Qualcare PPO/HMO/WC	$284.62

SODIUM HYALURONATE OPH 1% .4ML

Facility

$877.00

Hospital Charge Code	6005003
Hospital Revenue Code	250
Min. Negotiated Rate	$114.01
Max. Negotiated Rate	$438.50
Rate for Payer: Aetna Commercial	$263.10
Rate for Payer: Aetna Medicare Advantage	$263.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.63
Rate for Payer: Cigna Commercial	$438.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.01
Rate for Payer: Oxford Commercial	$438.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.55
Rate for Payer: UnitedHealthcare Commercial	$438.50

SODIUM HYALURONATE OPH 1% .4ML

Facility

$877.00

Hospital Charge Code	6005003
Hospital Revenue Code	250
Min. Negotiated Rate	$131.55
Max. Negotiated Rate	$131.55
Rate for Payer: Qualcare PPO/HMO/WC	$131.55

SODIUM HYALURONATE OPH1% .75ML

Facility

$1,196.00

Hospital Charge Code	6005011
Hospital Revenue Code	250
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$179.40

SODIUM HYALURONATE OPH1% .75ML

Facility

$1,196.00

Hospital Charge Code	6005011
Hospital Revenue Code	250
Min. Negotiated Rate	$155.48
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$358.80
Rate for Payer: Aetna Medicare Advantage	$358.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.98
Rate for Payer: Cigna Commercial	$598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.48
Rate for Payer: Oxford Commercial	$598.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.40
Rate for Payer: UnitedHealthcare Commercial	$598.00

Know your out-of-pocket cost for care.

All Charges