Heights University Hospital

All Charges

Charge

Type

Setting

Price

SULFANETHOXAZOLE/TAB

Facility

$1.00

Hospital Charge Code	60634706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

SULFANETHOXAZOLE/TAB

Facility

$1.00

Hospital Charge Code	60634706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SULFANILAMIDE 15%CR 120GM/AVC

Facility

$58.02

Service Code	NDC 37663104
Hospital Charge Code	60632092
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

SULFANILAMIDE 15%CR 120GM/AVC

Facility

$58.02

Service Code	NDC 37663104
Hospital Charge Code	60632092
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$29.01
Rate for Payer: Aetna Commercial	$17.41
Rate for Payer: Aetna Medicare Advantage	$17.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.80
Rate for Payer: Cigna Commercial	$29.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.54
Rate for Payer: Oxford Commercial	$29.01
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$29.01

SULFANILAMIDE (AVC) VAG CREAM

Facility

$217.55

Service Code	NDC 37663104
Hospital Charge Code	6063943247
Hospital Revenue Code	250
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$32.63
Rate for Payer: Qualcare PPO/HMO/WC	$32.63

SULFANILAMIDE (AVC) VAG CREAM

Facility

$217.55

Service Code	NDC 37663104
Hospital Charge Code	6063943247
Hospital Revenue Code	250
Min. Negotiated Rate	$28.28
Max. Negotiated Rate	$108.78
Rate for Payer: Aetna Commercial	$65.27
Rate for Payer: Aetna Medicare Advantage	$65.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.48
Rate for Payer: Cigna Commercial	$108.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.28
Rate for Payer: Oxford Commercial	$108.78
Rate for Payer: Qualcare PPO/HMO/WC	$32.63
Rate for Payer: UnitedHealthcare Commercial	$108.78

SULFANILAMIDE CMPO VAG 15%

Facility

$234.25

Hospital Charge Code	6005136
Hospital Revenue Code	251
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$35.14
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

SULFANILAMIDE CMPO VAG 15%

Facility

$234.25

Hospital Charge Code	6005136
Hospital Revenue Code	251
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$70.28
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.73
Rate for Payer: Cigna Commercial	$117.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.45
Rate for Payer: Oxford Commercial	$117.12
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Commercial	$117.12

SULFANILAMIDE CRM VAG 15%

Facility

$312.00

Hospital Charge Code	60628331
Hospital Revenue Code	250
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$46.80

SULFANILAMIDE CRM VAG 15%

Facility

$312.00

Hospital Charge Code	60628331
Hospital Revenue Code	250
Min. Negotiated Rate	$40.56
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.60
Rate for Payer: Aetna Medicare Advantage	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.56
Rate for Payer: Cigna Commercial	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.80
Rate for Payer: UnitedHealthcare Commercial	$156.00

SULFASALAZINE 500 MG TAB

Facility

$4.00

Service Code	NDC 603580121
Hospital Charge Code	60628716
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

SULFASALAZINE 500 MG TAB

Facility

$4.00

Service Code	NDC 603580121
Hospital Charge Code	60628716
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633932
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633930
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633931
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

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633932
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

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633931
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SULFASALAZINE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633930
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

SULFATED GPG - SGPG

Facility

$111.00

Hospital Charge Code	3031598E
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

SULFATED GPG - SGPG

Facility

$111.00

Hospital Charge Code	3031598E
Hospital Revenue Code	301
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.30
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

SULFATE URINE

Facility

$390.00

Service Code	HCPCS 84392
Hospital Charge Code	39990241K
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Aetna Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.12
Rate for Payer: Cigna Commercial	$5.49
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$5.65
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	$5.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.82
Rate for Payer: Wellcare Medicare Advantage	$5.49

SULFATE URINE

Facility

$390.00

Service Code	HCPCS 84392
Hospital Charge Code	39990241K
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SULFATE, URINE

Facility

$33.65

Service Code	HCPCS 84392
Hospital Charge Code	38477036
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Aetna Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.12
Rate for Payer: Cigna Commercial	$5.49
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.47
Rate for Payer: Humana Medicare Advantage	$5.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.82
Rate for Payer: Wellcare Medicare Advantage	$5.49

SULFATE, URINE

Facility

$33.65

Service Code	HCPCS 84392
Hospital Charge Code	38477036
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

SULFATIDE AUTO ANTIBODY

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001070
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

Know your out-of-pocket cost for care.

All Charges