Heights University Hospital

All Charges

Charge

Type

Setting

Price

SORB HI CARTRIDGE

Facility

$446.45

Hospital Charge Code	8200099
Hospital Revenue Code	271
Min. Negotiated Rate	$66.97
Max. Negotiated Rate	$66.97
Rate for Payer: Qualcare PPO/HMO/WC	$66.97

SORB HI CARTRIDGE

Facility

$446.45

Hospital Charge Code	8200099
Hospital Revenue Code	271
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$223.22
Rate for Payer: Aetna Commercial	$133.94
Rate for Payer: Aetna Medicare Advantage	$133.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.84
Rate for Payer: Cigna Commercial	$223.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.04
Rate for Payer: Oxford Commercial	$223.22
Rate for Payer: Qualcare PPO/HMO/WC	$66.97
Rate for Payer: UnitedHealthcare Commercial	$223.22

SORBITOL 70%/30ML

Facility

$27.14

Service Code	NDC 46287050030
Hospital Charge Code	60634966
Hospital Revenue Code	250
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.07

SORBITOL 70%/30ML

Facility

$27.14

Service Code	NDC 46287050030
Hospital Charge Code	60634966
Hospital Revenue Code	250
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$8.14
Rate for Payer: Aetna Medicare Advantage	$8.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.92
Rate for Payer: Cigna Commercial	$13.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.53
Rate for Payer: Oxford Commercial	$13.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.07
Rate for Payer: UnitedHealthcare Commercial	$13.57

SORBITOL 70%/473ML

Facility

$39.40

Service Code	NDC 10135013708
Hospital Charge Code	60633913
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$5.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.91

SORBITOL 70%/473ML

Facility

$39.40

Service Code	NDC 10135013708
Hospital Charge Code	60633913
Hospital Revenue Code	250
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$19.70
Rate for Payer: Aetna Commercial	$11.82
Rate for Payer: Aetna Medicare Advantage	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.05
Rate for Payer: Cigna Commercial	$19.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.12
Rate for Payer: Oxford Commercial	$19.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.91
Rate for Payer: UnitedHealthcare Commercial	$19.70

SORBITOL LQ 70% 16OZ

Facility

$2.45

Hospital Charge Code	6005045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SORBITOL LQ 70% 16OZ

Facility

$2.45

Hospital Charge Code	6005045
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

SORBITOL MANNITOL IRRIG 3000ml

Facility

$37.45

Hospital Charge Code	270650083
Hospital Revenue Code	270
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

SORBITOL MANNITOL IRRIG 3000ml

Facility

$37.45

Hospital Charge Code	270650083
Hospital Revenue Code	270
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: Aetna Medicare Advantage	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.55
Rate for Payer: Cigna Commercial	$18.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.87
Rate for Payer: Oxford Commercial	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$18.73

SORBITOL-MANNITOL IRRIG 3000ml

Facility

$61.80

Hospital Charge Code	270649323
Hospital Revenue Code	272
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$30.90
Rate for Payer: Aetna Commercial	$18.54
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.76
Rate for Payer: Cigna Commercial	$30.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.03
Rate for Payer: Oxford Commercial	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.27
Rate for Payer: UnitedHealthcare Commercial	$30.90

SORBITOL-MANNITOL IRRIG 3000ml

Facility

$61.80

Hospital Charge Code	270649323
Hospital Revenue Code	272
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$9.27

SORBITOL/MANNITOL IRRIGATION

Facility

$73.00

Hospital Charge Code	270335084
Hospital Revenue Code	272
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

SORBITOL/MANNITOL IRRIGATION

Facility

$73.00

Hospital Charge Code	270335084
Hospital Revenue Code	272
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

SORBITRATE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633914
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SORBITRATE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633914
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SORBITRATE CHEW/5MG

Facility

$3.00

Hospital Charge Code	60634829
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SORBITRATE CHEW/5MG

Facility

$3.00

Hospital Charge Code	60634829
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SORBITRATE CHEWABLE/5MG

Facility

$3.00

Hospital Charge Code	60634823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SORBITRATE CHEWABLE/5MG

Facility

$3.00

Hospital Charge Code	60634823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SORBITRATE SA/40MG/TAB

Facility

$3.00

Hospital Charge Code	60633915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

SORBITRATE SA/40MG/TAB

Facility

$3.00

Hospital Charge Code	60633915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SORIN COLLECTION RESERVOIR

Facility

$342.50

Hospital Charge Code	270659423
Hospital Revenue Code	272
Min. Negotiated Rate	$44.52
Max. Negotiated Rate	$171.25
Rate for Payer: Aetna Commercial	$102.75
Rate for Payer: Aetna Medicare Advantage	$102.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.34
Rate for Payer: Cigna Commercial	$171.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.52
Rate for Payer: Oxford Commercial	$171.25
Rate for Payer: Qualcare PPO/HMO/WC	$51.38
Rate for Payer: UnitedHealthcare Commercial	$171.25

SORIN COLLECTION RESERVOIR

Facility

$342.50

Hospital Charge Code	270659423
Hospital Revenue Code	272
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$51.38
Rate for Payer: Qualcare PPO/HMO/WC	$51.38

SOTALOL 120MG TAB

Facility

$22.91

Service Code	NDC 60505015900
Hospital Charge Code	60635771
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

Know your out-of-pocket cost for care.

All Charges