Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUCCINYLCHOLINE CHLR VIAL

Facility

$4.50

Hospital Charge Code	6013254
Hospital Revenue Code	250
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

SUCCINYLCHOLINE INJ 1GM

Facility

$5.65

Hospital Charge Code	60627491
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

SUCCINYLCHOLINE INJ 1GM

Facility

$5.65

Hospital Charge Code	60627491
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SUCRALFATE 1 GRAM/10ML

Facility

$67.40

Service Code	NDC 121074710
Hospital Charge Code	60629338
Hospital Revenue Code	250
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$10.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.11

SUCRALFATE 1 GRAM/10ML

Facility

$67.40

Service Code	NDC 121074710
Hospital Charge Code	60629338
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$33.70
Rate for Payer: Aetna Commercial	$20.22
Rate for Payer: Aetna Medicare Advantage	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.19
Rate for Payer: Cigna Commercial	$33.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.76
Rate for Payer: Oxford Commercial	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.11
Rate for Payer: UnitedHealthcare Commercial	$33.70

SUCRALFATE 1 G TAB

Facility

$5.36

Service Code	NDC 93221001
Hospital Charge Code	6016521
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$1.61
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.68

SUCRALFATE 1 G TAB

Facility

$5.36

Service Code	NDC 93221001
Hospital Charge Code	6016521
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SUCRALFATE/LIDOC VISC 120ML

Facility

$66.45

Hospital Charge Code	60628912
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$19.93
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.64
Rate for Payer: Oxford Commercial	$33.23
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$33.23

SUCRALFATE/LIDOC VISC 120ML

Facility

$66.45

Hospital Charge Code	60628912
Hospital Revenue Code	250
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

SUCRALFATE/MAGALUM/LIDOC 120ML

Facility

$194.45

Hospital Charge Code	60628931
Hospital Revenue Code	250
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$97.22
Rate for Payer: Aetna Commercial	$58.34
Rate for Payer: Aetna Medicare Advantage	$58.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.58
Rate for Payer: Cigna Commercial	$97.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.28
Rate for Payer: Oxford Commercial	$97.22
Rate for Payer: Qualcare PPO/HMO/WC	$29.17
Rate for Payer: UnitedHealthcare Commercial	$97.22

SUCRALFATE/MAGALUM/LIDOC 120ML

Facility

$194.45

Hospital Charge Code	60628931
Hospital Revenue Code	250
Min. Negotiated Rate	$29.17
Max. Negotiated Rate	$29.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.17

SUCRALFATE SUSP 1GM/10ML

Facility

$15.00

Hospital Charge Code	60635055
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

SUCRALFATE SUSP 1GM/10ML

Facility

$15.00

Hospital Charge Code	60635055
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

SUCROSE HE HEMOLYSINS/AGGLUTIN

Facility

$390.00

Service Code	HCPCS 86940
Hospital Charge Code	3035099
Hospital Revenue Code	302
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.41
Rate for Payer: Aetna Medicare Advantage	$8.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: Cigna Medicare Advantage	$4.38
Rate for Payer: Clover Medicare Advantage	$8.33
Rate for Payer: EmblemHealth Commercial	$26.31
Rate for Payer: Humana Medicare Advantage	$9.03
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	$8.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.30
Rate for Payer: Wellcare Medicare Advantage	$8.77

SUCROSE HE HEMOLYSINS/AGGLUTIN

Facility

$390.00

Service Code	HCPCS 86940
Hospital Charge Code	3035099
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SUCTION*******

Facility

$22.00

Hospital Charge Code	9500060
Hospital Revenue Code	279
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$11.00

SUCTION*******

Facility

$22.00

Hospital Charge Code	9500060
Hospital Revenue Code	279
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

SUCTION CATH *******

Facility

$7.00

Hospital Charge Code	8001612
Hospital Revenue Code	279
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

SUCTION CATH *******

Facility

$7.00

Hospital Charge Code	8001612
Hospital Revenue Code	279
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SUCTION COAG L HOOK 5 MM X 32

Facility

$2,086.90

Hospital Charge Code	270688620
Hospital Revenue Code	272
Min. Negotiated Rate	$271.30
Max. Negotiated Rate	$1,043.45
Rate for Payer: Aetna Commercial	$626.07
Rate for Payer: Aetna Medicare Advantage	$626.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.16
Rate for Payer: Cigna Commercial	$1,043.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.30
Rate for Payer: Oxford Commercial	$1,043.45
Rate for Payer: Qualcare PPO/HMO/WC	$313.04
Rate for Payer: UnitedHealthcare Commercial	$1,043.45

SUCTION COAG L HOOK 5 MM X 32

Facility

$2,086.90

Hospital Charge Code	270688620
Hospital Revenue Code	272
Min. Negotiated Rate	$313.04
Max. Negotiated Rate	$313.04
Rate for Payer: Qualcare PPO/HMO/WC	$313.04

SUCTION COAGULATOR

Facility

$58.15

Hospital Charge Code	270650795
Hospital Revenue Code	272
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$29.07
Rate for Payer: Aetna Commercial	$17.45
Rate for Payer: Aetna Medicare Advantage	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.83
Rate for Payer: Cigna Commercial	$29.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.56
Rate for Payer: Oxford Commercial	$29.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.72
Rate for Payer: UnitedHealthcare Commercial	$29.07

SUCTION COAGULATOR

Facility

$58.15

Hospital Charge Code	270650795
Hospital Revenue Code	272
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$8.72
Rate for Payer: Qualcare PPO/HMO/WC	$8.72

SUCTION COAGULATOR 10FR 6

Facility

$70.54

Hospital Charge Code	270651005
Hospital Revenue Code	272
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$35.27
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.99
Rate for Payer: Cigna Commercial	$35.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.17
Rate for Payer: Oxford Commercial	$35.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.58
Rate for Payer: UnitedHealthcare Commercial	$35.27

SUCTION COAGULATOR 10FR 6

Facility

$70.54

Hospital Charge Code	270651005
Hospital Revenue Code	272
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$10.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.58

Know your out-of-pocket cost for care.

All Charges