Heights University Hospital

All Charges

Charge

Type

Setting

Price

CEFPODOXIME TAB 200MG

Facility

$56.68

Service Code	NDC 65862009620
Hospital Charge Code	60629250
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

CEFPODOXIME TAB 200MG

Facility

$56.68

Service Code	NDC 65862009620
Hospital Charge Code	60629250
Hospital Revenue Code	250
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$28.34
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.37
Rate for Payer: Oxford Commercial	$28.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$28.34

CEFTAZIDIME 2 GM VIAL

Facility

$222.45

Hospital Charge Code	6007272
Hospital Revenue Code	636
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$111.22
Rate for Payer: Aetna Commercial	$66.73
Rate for Payer: Aetna Medicare Advantage	$66.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.72
Rate for Payer: Cigna Commercial	$111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.37

CEFTAZIDIME 2 GM VIAL

Facility

$222.45

Hospital Charge Code	6007272
Hospital Revenue Code	636
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$53.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.37

CEFTAZIDIME/AVIBACTAM 2/0.5GM

Facility

$1,710.00

Hospital Charge Code	6063943370
Hospital Revenue Code	250
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$256.50
Rate for Payer: Qualcare PPO/HMO/WC	$256.50

CEFTAZIDIME/AVIBACTAM 2/0.5GM

Facility

$1,710.00

Hospital Charge Code	6063943370
Hospital Revenue Code	250
Min. Negotiated Rate	$222.30
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.05
Rate for Payer: Cigna Commercial	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.30
Rate for Payer: Oxford Commercial	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$256.50
Rate for Payer: UnitedHealthcare Commercial	$855.00

CEFTAZIDIME (FORTAZ) 1 G INJ

Facility

$111.25

Hospital Charge Code	6007124
Hospital Revenue Code	636
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$26.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

CEFTAZIDIME (FORTAZ) 1 G INJ

Facility

$111.25

Hospital Charge Code	6007124
Hospital Revenue Code	636
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$33.38
Rate for Payer: Aetna Medicare Advantage	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.37
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

CEFTAZIDIME IVPB ODD DOSE >1G

Facility

$177.95

Hospital Charge Code	60627260
Hospital Revenue Code	250
Min. Negotiated Rate	$26.69
Max. Negotiated Rate	$26.69
Rate for Payer: Qualcare PPO/HMO/WC	$26.69

CEFTAZIDIME IVPB ODD DOSE >1G

Facility

$177.95

Hospital Charge Code	60627260
Hospital Revenue Code	250
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$88.97
Rate for Payer: Aetna Commercial	$53.38
Rate for Payer: Aetna Medicare Advantage	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.38
Rate for Payer: Cigna Commercial	$88.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.13
Rate for Payer: Oxford Commercial	$88.97
Rate for Payer: Qualcare PPO/HMO/WC	$26.69
Rate for Payer: UnitedHealthcare Commercial	$88.97

CEFTIN/125MG

Facility

$6.00

Hospital Charge Code	60634657
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CEFTIN/125MG

Facility

$6.00

Hospital Charge Code	60634657
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

CEFTIN/125MG/UD

Facility

$6.00

Hospital Charge Code	60634658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CEFTIN/125MG/UD

Facility

$6.00

Hospital Charge Code	60634658
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

CEFTIN/200ML

Facility

$95.00

Hospital Charge Code	60635001
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

CEFTIN/200ML

Facility

$95.00

Hospital Charge Code	60635001
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CEFTIN/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632661
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CEFTIN/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632661
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

CEFTIN/250MG/UD

Facility

$18.00

Hospital Charge Code	60634659
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

CEFTIN/250MG/UD

Facility

$18.00

Hospital Charge Code	60634659
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

CEFTIN/500MG/TAB

Facility

$28.00

Hospital Charge Code	60632662
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

CEFTIN/500MG/TAB

Facility

$28.00

Hospital Charge Code	60632662
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

CEFTIN/500MG/UD

Facility

$13.00

Hospital Charge Code	60634660
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

CEFTIN/500MG/UD

Facility

$13.00

Hospital Charge Code	60634660
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CEFTIN SUSP/100ML

Facility

$95.00

Hospital Charge Code	60635000
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

Know your out-of-pocket cost for care.

All Charges