Heights University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM NITROPRUSSIDE/50MG

Facility

$34.00

Hospital Charge Code	60633908
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

SODIUM NITROPRUSSIDE/50MG

Facility

$34.00

Hospital Charge Code	60633908
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

SODIUM;OTHER SOURCE

Facility

$34.00

Service Code	HCPCS 84302
Hospital Charge Code	38477039
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	$4.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
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;OTHER SOURCE

Facility

$34.00

Service Code	HCPCS 84302
Hospital Charge Code	38477039
Hospital Revenue Code	301
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

SODIUM PHOS 16.2G/BIPHOS 43.2G

Facility

$10.90

Hospital Charge Code	6010045
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

SODIUM PHOS 16.2G/BIPHOS 43.2G

Facility

$10.90

Hospital Charge Code	6010045
Hospital Revenue Code	251
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 PHOS BIPHOSPHATE 118M

Facility

$4.50

Hospital Charge Code	6013205
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

SODIUM PHOS BIPHOSPHATE 118M

Facility

$4.50

Hospital Charge Code	6013205
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

SODIUM PHOS BIPHOSPHATE LQ

Facility

$14.05

Hospital Charge Code	60628137
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$7.03
Rate for Payer: Aetna Commercial	$4.21
Rate for Payer: Aetna Medicare Advantage	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.58
Rate for Payer: Cigna Commercial	$7.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.83
Rate for Payer: Oxford Commercial	$7.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.11
Rate for Payer: UnitedHealthcare Commercial	$7.03

SODIUM PHOS BIPHOSPHATE LQ

Facility

$14.05

Hospital Charge Code	60628137
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.11

SODIUM PHOS INJ 15ML

Facility

$9.58

Service Code	NDC 409739172
Hospital Charge Code	60627936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$4.79

SODIUM PHOS INJ 15ML

Facility

$9.58

Service Code	NDC 409739172
Hospital Charge Code	60627936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

SODIUM PHOSPHATE INJ/3MM

Facility

$5.00

Hospital Charge Code	60634800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SODIUM PHOSPHATE INJ/3MM

Facility

$5.00

Hospital Charge Code	60634800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

SODIUM PLSTY SLF/SUP 1.25G 5ML

Facility

$64.00

Hospital Charge Code	6004931
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

SODIUM PLSTY SLF/SUP 1.25G 5ML

Facility

$64.00

Hospital Charge Code	6004931
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 PLSTY SULF SSP15GM/60ML

Facility

$207.70

Service Code	NDC 46287000660
Hospital Charge Code	60627940
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$103.85
Rate for Payer: Aetna Commercial	$62.31
Rate for Payer: Aetna Medicare Advantage	$62.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.96
Rate for Payer: Cigna Commercial	$103.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$103.85
Rate for Payer: Qualcare PPO/HMO/WC	$31.16
Rate for Payer: UnitedHealthcare Commercial	$103.85

SODIUM PLSTY SULF SSP15GM/60ML

Facility

$207.70

Service Code	NDC 46287000660
Hospital Charge Code	60627940
Hospital Revenue Code	250
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$31.16
Rate for Payer: Qualcare PPO/HMO/WC	$31.16

SODIUM POLYSTYRENE SULFON

Facility

$48.00

Hospital Charge Code	60633909
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SODIUM POLYSTYRENE SULFON

Facility

$48.00

Hospital Charge Code	60633909
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

SODIUM, RANDOM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002481
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.39
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.54
Rate for Payer: Cigna Commercial	$5.06
Rate for Payer: Cigna Medicare Advantage	$2.53
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.36
Rate for Payer: Wellcare Medicare Advantage	$5.06

SODIUM, RANDOM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002481
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, SERUM

Facility

$94.00

Service Code	HCPCS 84295
Hospital Charge Code	38472608
Hospital Revenue Code	301
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.62
Rate for Payer: Cigna Commercial	$4.81
Rate for Payer: Cigna Medicare Advantage	$2.40
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.10
Rate for Payer: Wellcare Medicare Advantage	$4.81

SODIUM, SERUM

Facility

$94.00

Service Code	HCPCS 84295
Hospital Charge Code	38472608
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

SODIUM, SERUM (NA)

Facility

$390.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges