Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUGAMMADEX 500MG VIAL

Facility

$1,398.96

Service Code	NDC 6542315
Hospital Charge Code	606390162
Hospital Revenue Code	250
Min. Negotiated Rate	$181.86
Max. Negotiated Rate	$699.48
Rate for Payer: Aetna Commercial	$419.69
Rate for Payer: Aetna Medicare Advantage	$419.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$356.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$356.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$356.73
Rate for Payer: Cigna Commercial	$699.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.86
Rate for Payer: Oxford Commercial	$699.48
Rate for Payer: Qualcare PPO/HMO/WC	$209.84
Rate for Payer: UnitedHealthcare Commercial	$699.48

SUGAMMADEX 500MG VIAL

Facility

$1,398.96

Service Code	NDC 6542315
Hospital Charge Code	606390162
Hospital Revenue Code	250
Min. Negotiated Rate	$209.84
Max. Negotiated Rate	$209.84
Rate for Payer: Qualcare PPO/HMO/WC	$209.84

SUGAR SINGLE QUAN EACH SPECI

Facility

$454.00

Service Code	HCPCS 84378
Hospital Charge Code	3008255
Hospital Revenue Code	301
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$68.10
Rate for Payer: Qualcare PPO/HMO/WC	$68.10

SUGAR SINGLE QUAN EACH SPECI

Facility

$454.00

Service Code	HCPCS 84378
Hospital Charge Code	3008255
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

SUGARS MULT QUAL @ SPECIMENT

Facility

$39.00

Service Code	HCPCS 84377
Hospital Charge Code	38477044
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.82
Rate for Payer: Aetna Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.15
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.83
Rate for Payer: Wellcare Medicare Advantage	$5.50

SUGARS MULT QUAL @ SPECIMENT

Facility

$39.00

Service Code	HCPCS 84377
Hospital Charge Code	38477044
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

SUGARS SING QUAL @ SPECIMEN

Facility

$39.00

Service Code	HCPCS 84376
Hospital Charge Code	38477043
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

SUGARS SING QUAL @ SPECIMEN

Facility

$39.00

Service Code	HCPCS 84376
Hospital Charge Code	38477043
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.82
Rate for Payer: Aetna Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.15
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.83
Rate for Payer: Wellcare Medicare Advantage	$5.50

SUGAR WATER TEST (BLOOD)

Facility

$67.25

Service Code	HCPCS 86941
Hospital Charge Code	3008257
Hospital Revenue Code	302
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SUGAR WATER TEST (BLOOD)

Facility

$67.25

Service Code	HCPCS 86941
Hospital Charge Code	3008257
Hospital Revenue Code	302
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.24
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$12.11
Rate for Payer: Cigna Medicare Advantage	$6.05
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.84
Rate for Payer: Wellcare Medicare Advantage	$12.11

Sulfacetamide 10% opht soln 15

Facility

$351.97

Hospital Charge Code	6063943294
Hospital Revenue Code	250
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$175.99
Rate for Payer: Aetna Commercial	$105.59
Rate for Payer: Aetna Medicare Advantage	$105.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.75
Rate for Payer: Cigna Commercial	$175.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.76
Rate for Payer: Oxford Commercial	$175.99
Rate for Payer: Qualcare PPO/HMO/WC	$52.80
Rate for Payer: UnitedHealthcare Commercial	$175.99

Sulfacetamide 10% opht soln 15

Facility

$351.97

Hospital Charge Code	6063943294
Hospital Revenue Code	250
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$52.80

SULFACETAMIDE PREDNIS SOL OPH

Facility

$24.85

Hospital Charge Code	60628715
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$7.46
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$12.43

SULFACETAMIDE PREDNIS SOL OPH

Facility

$24.85

Hospital Charge Code	60628715
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SULFACETAMIDE PREDNIS SSP OPH

Facility

$274.45

Hospital Charge Code	60628030
Hospital Revenue Code	250
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$137.22
Rate for Payer: Aetna Commercial	$82.33
Rate for Payer: Aetna Medicare Advantage	$82.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.98
Rate for Payer: Cigna Commercial	$137.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.68
Rate for Payer: Oxford Commercial	$137.22
Rate for Payer: Qualcare PPO/HMO/WC	$41.17
Rate for Payer: UnitedHealthcare Commercial	$137.22

SULFACETAMIDE PREDNIS SSP OPH

Facility

$164.00

Hospital Charge Code	60628029
Hospital Revenue Code	250
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$82.00
Rate for Payer: Aetna Commercial	$49.20
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$82.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$82.00

SULFACETAMIDE PREDNIS SSP OPH

Facility

$164.00

Hospital Charge Code	60628029
Hospital Revenue Code	250
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

SULFACETAMIDE PREDNIS SSP OPH

Facility

$274.45

Hospital Charge Code	60628030
Hospital Revenue Code	250
Min. Negotiated Rate	$41.17
Max. Negotiated Rate	$41.17
Rate for Payer: Qualcare PPO/HMO/WC	$41.17

SULFACETAMIDE SD ONTOPH10%3.5G

Facility

$101.80

Hospital Charge Code	6005102
Hospital Revenue Code	251
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$15.27
Rate for Payer: Qualcare PPO/HMO/WC	$15.27

SULFACETAMIDE SD ONTOPH10%3.5G

Facility

$101.80

Hospital Charge Code	6005102
Hospital Revenue Code	251
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$50.90
Rate for Payer: Aetna Commercial	$30.54
Rate for Payer: Aetna Medicare Advantage	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.96
Rate for Payer: Cigna Commercial	$50.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.23
Rate for Payer: Oxford Commercial	$50.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.27
Rate for Payer: UnitedHealthcare Commercial	$50.90

SULFACETAMIDE SD OPH 10% 1ML

Facility

$34.60

Hospital Charge Code	6005110
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

SULFACETAMIDE SD OPH 10% 1ML

Facility

$34.60

Hospital Charge Code	6005110
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

SULFACETAMIDE SODIUM 10%

Facility

$6.00

Hospital Charge Code	60633925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

SULFACETAMIDE SODIUM 10%

Facility

$5.00

Hospital Charge Code	60633926
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

SULFACETAMIDE SODIUM 10%

Facility

$5.00

Hospital Charge Code	60633926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

Know your out-of-pocket cost for care.

All Charges