Heights University Hospital

All Charges

Charge

Type

Setting

Price

SULFACETAMIDE SODIUM 10%

Facility

$6.00

Hospital Charge Code	60633925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SULFACE TAM-PRED OPH OIN 3.5GR

Facility

$772.78

Service Code	NDC 23031304
Hospital Charge Code	60628802
Hospital Revenue Code	250
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$115.92
Rate for Payer: Qualcare PPO/HMO/WC	$115.92

SULFACE TAM-PRED OPH OIN 3.5GR

Facility

$772.78

Service Code	NDC 23031304
Hospital Charge Code	60628802
Hospital Revenue Code	250
Min. Negotiated Rate	$100.46
Max. Negotiated Rate	$386.39
Rate for Payer: Aetna Commercial	$231.83
Rate for Payer: Aetna Medicare Advantage	$231.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.06
Rate for Payer: Cigna Commercial	$386.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.46
Rate for Payer: Oxford Commercial	$386.39
Rate for Payer: Qualcare PPO/HMO/WC	$115.92
Rate for Payer: UnitedHealthcare Commercial	$386.39

SULFACETM SD OPTH 10% 5ML

Facility

$101.80

Hospital Charge Code	6005128
Hospital Revenue Code	251
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$15.27
Rate for Payer: Qualcare PPO/HMO/WC	$15.27

SULFACETM SD OPTH 10% 5ML

Facility

$101.80

Hospital Charge Code	6005128
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

SULFADIAZINE/500MG

Facility

$3.00

Hospital Charge Code	60634750
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

SULFADIAZINE/500MG

Facility

$3.00

Hospital Charge Code	60634750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFADIAZINE 500 MG TAB

Facility

$33.84

Service Code	NDC 185075701
Hospital Charge Code	60629052
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$16.92
Rate for Payer: Aetna Commercial	$10.15
Rate for Payer: Aetna Medicare Advantage	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.63
Rate for Payer: Cigna Commercial	$16.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.40
Rate for Payer: Oxford Commercial	$16.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.08
Rate for Payer: UnitedHealthcare Commercial	$16.92

SULFADIAZINE 500 MG TAB

Facility

$33.84

Service Code	NDC 185075701
Hospital Charge Code	60629052
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$5.08

SULFAMETHOXA/TRIMETHOPRIM

Facility

$4.00

Hospital Charge Code	60633928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SULFAMETHOXA/TRIMETHOPRIM

Facility

$3.00

Hospital Charge Code	60633927
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFAMETHOXA/TRIMETHOPRIM

Facility

$3.00

Hospital Charge Code	60633927
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Cigna Commercial	$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: 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

SULFAMETHOXA/TRIMETHOPRIM

Facility

$4.00

Hospital Charge Code	60633928
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETHOXAZOLE/TRIMETHO

Facility

$3.00

Hospital Charge Code	60633929
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

SULFAMETHOXAZOLE/TRIMETHO

Facility

$3.00

Hospital Charge Code	60633929
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFAMETHOX+TRIMETH 10ML

Facility

$4.00

Hospital Charge Code	60635081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETHOX+TRIMETH 10ML

Facility

$4.00

Hospital Charge Code	60635081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SULFAMETH TRIME 200/40MG/5ML

Facility

$4.00

Service Code	NDC 50383082416
Hospital Charge Code	60627357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFAMETH TRIME 200/40MG/5ML

Facility

$4.00

Service Code	NDC 50383082416
Hospital Charge Code	60627357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SULFAMETH TRIME TABDS800/160MG

Facility

$9.38

Service Code	NDC 53746027201
Hospital Charge Code	60627359
Hospital Revenue Code	251
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$2.81
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$4.69

SULFAMETH TRIME TABDS800/160MG

Facility

$9.38

Service Code	NDC 53746027201
Hospital Charge Code	60627359
Hospital Revenue Code	251
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

SULFAMETH TRIME TAB SS400/80MG

Facility

$4.96

Service Code	NDC 68084074795
Hospital Charge Code	60627360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Qualcare PPO/HMO/WC	$0.74

SULFAMETH TRIME TAB SS400/80MG

Facility

$4.96

Service Code	NDC 68084074795
Hospital Charge Code	60627360
Hospital Revenue Code	251
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna Commercial	$1.49
Rate for Payer: Aetna Medicare Advantage	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.26
Rate for Payer: Cigna Commercial	$2.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.64
Rate for Payer: Oxford Commercial	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.74
Rate for Payer: UnitedHealthcare Commercial	$2.48

SULFAMETH-TRIMETH

Facility

$4,033.40

Service Code	NDC 703950303
Hospital Charge Code	60627358
Hospital Revenue Code	250
Min. Negotiated Rate	$605.01
Max. Negotiated Rate	$605.01
Rate for Payer: Qualcare PPO/HMO/WC	$605.01

SULFAMETH-TRIMETH

Facility

$4,033.40

Service Code	NDC 703950303
Hospital Charge Code	60627358
Hospital Revenue Code	250
Min. Negotiated Rate	$524.34
Max. Negotiated Rate	$2,016.70
Rate for Payer: Aetna Commercial	$1,210.02
Rate for Payer: Aetna Medicare Advantage	$1,210.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.52
Rate for Payer: Cigna Commercial	$2,016.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.34
Rate for Payer: Oxford Commercial	$2,016.70
Rate for Payer: Qualcare PPO/HMO/WC	$605.01
Rate for Payer: UnitedHealthcare Commercial	$2,016.70

Know your out-of-pocket cost for care.

All Charges