Heights University Hospital

All Charges

Charge

Type

Setting

Price

SULFATIDE AUTO ANTIBODY

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001070
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

SULFA TRIPLE 1MG

Facility

$61.63

Hospital Charge Code	270669738
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$9.24
Rate for Payer: Qualcare PPO/HMO/WC	$9.24

SULFA TRIPLE 1MG

Facility

$61.63

Hospital Charge Code	270669738
Hospital Revenue Code	272
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$30.82
Rate for Payer: Aetna Commercial	$18.49
Rate for Payer: Aetna Medicare Advantage	$18.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.72
Rate for Payer: Cigna Commercial	$30.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.01
Rate for Payer: Oxford Commercial	$30.82
Rate for Payer: Qualcare PPO/HMO/WC	$9.24
Rate for Payer: UnitedHealthcare Commercial	$30.82

SULFISOXASOLE OPH DROP

Facility

$86.40

Hospital Charge Code	6007348
Hospital Revenue Code	252
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

SULFISOXASOLE OPH DROP

Facility

$86.40

Hospital Charge Code	6007348
Hospital Revenue Code	252
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$43.20

SULFISOXAZOLE 500 MG TAB

Facility

$4.00

Hospital Charge Code	60627350
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SULFISOXAZOLE 500 MG TAB

Facility

$4.00

Hospital Charge Code	60627350
Hospital Revenue Code	251
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

SULFONAMIDES UNDIFF SERUM/PLSM

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401180299
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SULFONAMIDES UNDIFF SERUM/PLSM

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401180299
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
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	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

SULFONYLUREA

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472607
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

SULFONYLUREA

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472607
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

SULFONYLUREA SCREEN QT, UR

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3038114
Hospital Revenue Code	300
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

SULFONYLUREA SCREEN QT, UR

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3038114
Hospital Revenue Code	300
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

SULFUR-SALICYLIC SHAMPOO

Facility

$67.25

Hospital Charge Code	60628436
Hospital Revenue Code	250
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$33.62
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$33.62

SULFUR-SALICYLIC SHAMPOO

Facility

$67.25

Hospital Charge Code	60628436
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SULINDAC 150 MG TAB

Facility

$9.65

Hospital Charge Code	60627697
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SULINDAC 150 MG TAB

Facility

$9.65

Hospital Charge Code	60627697
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

SULINDAC 200 MG TAB

Facility

$11.25

Hospital Charge Code	60627698
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

SULINDAC 200 MG TAB

Facility

$11.25

Hospital Charge Code	60627698
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

SUMATRIPTAN 25 MG TAB

Facility

$222.78

Service Code	NDC 173073500
Hospital Charge Code	60629927
Hospital Revenue Code	250
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$111.39
Rate for Payer: Aetna Commercial	$66.83
Rate for Payer: Aetna Medicare Advantage	$66.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.81
Rate for Payer: Cigna Commercial	$111.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.96
Rate for Payer: Oxford Commercial	$111.39
Rate for Payer: Qualcare PPO/HMO/WC	$33.42
Rate for Payer: UnitedHealthcare Commercial	$111.39

SUMATRIPTAN 25 MG TAB

Facility

$222.78

Service Code	NDC 173073500
Hospital Charge Code	60629927
Hospital Revenue Code	250
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$33.42
Rate for Payer: Qualcare PPO/HMO/WC	$33.42

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$569.50

Service Code	HCPCS J3030
Hospital Charge Code	6007728
Hospital Revenue Code	636
Min. Negotiated Rate	$85.42
Max. Negotiated Rate	$137.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.42

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$569.50

Service Code	HCPCS J3030
Hospital Charge Code	6007728
Hospital Revenue Code	636
Min. Negotiated Rate	$85.42
Max. Negotiated Rate	$284.75
Rate for Payer: Aetna Commercial	$170.85
Rate for Payer: Aetna Medicare Advantage	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.22
Rate for Payer: Cigna Commercial	$284.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.42

SUMP PUMP ************

Facility

$153.00

Hospital Charge Code	8001695
Hospital Revenue Code	279
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

SUMP PUMP ************

Facility

$153.00

Hospital Charge Code	8001695
Hospital Revenue Code	279
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.89
Rate for Payer: Oxford Commercial	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$76.50

Know your out-of-pocket cost for care.

All Charges