Heights University Hospital

All Charges

Charge

Type

Setting

Price

CEFEPIME 2 GRAM VIAL

Facility

$19.00

Hospital Charge Code	60635119
Hospital Revenue Code	636
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

CEFEPIME 2 GRAM VIAL

Facility

$19.00

Hospital Charge Code	60635119
Hospital Revenue Code	636
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

CEFEPIME HCL 5% 2MG 50ML PB

Facility

$139.76

Service Code	HCPCS J0703
Hospital Charge Code	606494028
Hospital Revenue Code	636
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$41.93
Rate for Payer: Aetna Commercial	$41.93
Rate for Payer: Aetna Medicare Advantage	$41.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.64
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.82
Rate for Payer: Qualcare PPO/HMO/WC	$20.96

CEFEPIME HCL 5% 2MG 50ML PB

Facility

$139.76

Service Code	HCPCS J0703
Hospital Charge Code	606494028
Hospital Revenue Code	636
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$33.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.82
Rate for Payer: Qualcare PPO/HMO/WC	$20.96

CEFEPIME INJ 1G

Facility

$98.60

Hospital Charge Code	60628988
Hospital Revenue Code	250
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$49.30
Rate for Payer: Aetna Commercial	$29.58
Rate for Payer: Aetna Medicare Advantage	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.14
Rate for Payer: Cigna Commercial	$49.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.82
Rate for Payer: Oxford Commercial	$49.30
Rate for Payer: Qualcare PPO/HMO/WC	$14.79
Rate for Payer: UnitedHealthcare Commercial	$49.30

CEFEPIME INJ 1G

Facility

$98.60

Hospital Charge Code	60628988
Hospital Revenue Code	250
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$14.79
Rate for Payer: Qualcare PPO/HMO/WC	$14.79

CEFEPIME IVPB 1G/NACL 50ML

Facility

$98.60

Hospital Charge Code	60628987
Hospital Revenue Code	250
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$14.79
Rate for Payer: Qualcare PPO/HMO/WC	$14.79

CEFEPIME IVPB 1G/NACL 50ML

Facility

$98.60

Hospital Charge Code	60628987
Hospital Revenue Code	250
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$49.30
Rate for Payer: Aetna Commercial	$29.58
Rate for Payer: Aetna Medicare Advantage	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.14
Rate for Payer: Cigna Commercial	$49.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.82
Rate for Payer: Oxford Commercial	$49.30
Rate for Payer: Qualcare PPO/HMO/WC	$14.79
Rate for Payer: UnitedHealthcare Commercial	$49.30

CEFEPIME IVPB 2G/NACL 100ML

Facility

$195.85

Hospital Charge Code	60628990
Hospital Revenue Code	250
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$97.92
Rate for Payer: Aetna Commercial	$58.76
Rate for Payer: Aetna Medicare Advantage	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$97.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.46
Rate for Payer: Oxford Commercial	$97.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.38
Rate for Payer: UnitedHealthcare Commercial	$97.92

CEFEPIME IVPB 2G/NACL 100ML

Facility

$195.85

Hospital Charge Code	60628990
Hospital Revenue Code	250
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.38

CEFEPIME (MAXIPIME) 1 G INJ

Facility

$427.06

Service Code	HCPCS J0692
Hospital Charge Code	60628986
Hospital Revenue Code	636
Min. Negotiated Rate	$64.06
Max. Negotiated Rate	$103.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.06

CEFEPIME (MAXIPIME) 1 G INJ

Facility

$427.06

Service Code	HCPCS J0692
Hospital Charge Code	60628986
Hospital Revenue Code	636
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$128.12
Rate for Payer: Aetna Commercial	$128.12
Rate for Payer: Aetna Medicare Advantage	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.90
Rate for Payer: Cigna Commercial	$1.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.06

CEFEPIME (MAXIPIME) 2 G INJ

Facility

$342.37

Service Code	HCPCS J0692
Hospital Charge Code	60628989
Hospital Revenue Code	636
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$102.71
Rate for Payer: Aetna Commercial	$102.71
Rate for Payer: Aetna Medicare Advantage	$102.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.30
Rate for Payer: Cigna Commercial	$1.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.36

CEFEPIME (MAXIPIME) 2 G INJ

Facility

$342.37

Service Code	HCPCS J0692
Hospital Charge Code	60628989
Hospital Revenue Code	636
Min. Negotiated Rate	$51.36
Max. Negotiated Rate	$82.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.36

CEFIXIME SSP 100MG/5ML 50ML

Facility

$19.50

Hospital Charge Code	60627258
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.92

CEFIXIME SSP 100MG/5ML 50ML

Facility

$19.50

Hospital Charge Code	60627258
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.97
Rate for Payer: Cigna Commercial	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.54
Rate for Payer: Oxford Commercial	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.92
Rate for Payer: UnitedHealthcare Commercial	$9.75

CEFIZOX/10GM

Facility

$124.00

Hospital Charge Code	60632655
Hospital Revenue Code	250
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

CEFIZOX/10GM

Facility

$66.00

Hospital Charge Code	60632657
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

CEFIZOX/10GM

Facility

$124.00

Hospital Charge Code	60632655
Hospital Revenue Code	250
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$62.00

CEFIZOX/10GM

Facility

$66.00

Hospital Charge Code	60632657
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CEFIZOX/1GM

Facility

$72.00

Hospital Charge Code	60632654
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

CEFIZOX/1GM

Facility

$72.00

Hospital Charge Code	60632658
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

CEFIZOX/1GM

Facility

$72.00

Hospital Charge Code	60632654
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

CEFIZOX/1GM

Facility

$72.00

Hospital Charge Code	60632658
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

CEFIZOX 1GM/50ML

Facility

$63.00

Hospital Charge Code	60635024
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

Know your out-of-pocket cost for care.

All Charges