Heights University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM, SERUM (NA)

Facility

$390.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474
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	$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	$4.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.10
Rate for Payer: Wellcare Medicare Advantage	$4.81

SODIUM,SERUM NA PANEL

Facility

$16.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474P
Hospital Revenue Code	301
Min. Negotiated Rate	$2.08
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	$2.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
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 NA PANEL

Facility

$16.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474P
Hospital Revenue Code	301
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SODIUM TETRAD INJ 1%

Facility

$74.90

Hospital Charge Code	60627664
Hospital Revenue Code	250
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$22.47
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.74
Rate for Payer: Oxford Commercial	$37.45
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$37.45

SODIUM TETRAD INJ 1%

Facility

$74.90

Hospital Charge Code	60627664
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

SODIUM TETRAD INJ 3%

Facility

$128.75

Hospital Charge Code	60627665
Hospital Revenue Code	250
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

SODIUM TETRAD INJ 3%

Facility

$128.75

Hospital Charge Code	60627665
Hospital Revenue Code	250
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$64.38
Rate for Payer: Aetna Commercial	$38.62
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.83
Rate for Payer: Cigna Commercial	$64.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$64.38
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$64.38

SODIUM TETRAD SULF INJ 1% 2ML

Facility

$48.00

Hospital Charge Code	6005029
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SODIUM TETRAD SULF INJ 1% 2ML

Facility

$48.00

Hospital Charge Code	6005029
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 TETRAD SULF INJ 3% 2ML

Facility

$109.45

Hospital Charge Code	6005037
Hospital Revenue Code	250
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$54.73

SODIUM TETRAD SULF INJ 3% 2ML

Facility

$109.45

Hospital Charge Code	6005037
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	39990241J
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	39990241J
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, URINE

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38472611
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	$15.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
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, URINE

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38472611
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

SODIUM, URINE 24 HOUR

Facility

$46.00

Service Code	HCPCS 84300
Hospital Charge Code	3030830
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	$5.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
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, URINE 24 HOUR

Facility

$46.00

Service Code	HCPCS 84300
Hospital Charge Code	3030830
Hospital Revenue Code	301
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

SODIUM, URINE 24 HOUR

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002482
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, URINE 24 HOUR

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002482
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SOFAMOR DANEK

Facility

$400.00

Hospital Charge Code	270339543
Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$200.00

SOFAMOR DANEK

Facility

$400.00

Hospital Charge Code	270339543
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

SOF-FOAM DRESSING 4X5

Facility

$11.00

Hospital Charge Code	9808240
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$5.50

SOF-FOAM DRESSING 4X5

Facility

$11.00

Hospital Charge Code	9808240
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

SOFRADIM MESH PCO-1510 6X4

Facility

$905.00

Hospital Charge Code	270338746
Hospital Revenue Code	278
Min. Negotiated Rate	$135.75
Max. Negotiated Rate	$219.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.01
Rate for Payer: Qualcare PPO/HMO/WC	$135.75

SOFRADIM MESH PCO-1510 6X4

Facility

$905.00

Hospital Charge Code	270338746
Hospital Revenue Code	278
Min. Negotiated Rate	$135.75
Max. Negotiated Rate	$452.50
Rate for Payer: Aetna Commercial	$271.50
Rate for Payer: Aetna Medicare Advantage	$271.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.78
Rate for Payer: Cigna Commercial	$452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.01
Rate for Payer: Qualcare PPO/HMO/WC	$135.75

Know your out-of-pocket cost for care.

All Charges