Heights University Hospital

All Charges

Charge

Type

Setting

Price

CEFTIN SUSP/100ML

Facility

$95.00

Hospital Charge Code	60635000
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CEFTIN SUSP/50ML

Facility

$95.00

Hospital Charge Code	60634999
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CEFTIN SUSP/50ML

Facility

$95.00

Hospital Charge Code	60634999
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

CEFTIZOXIME VL 1GM

Facility

$32.00

Hospital Charge Code	6001051
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

CEFTIZOXIME VL 1GM

Facility

$32.00

Hospital Charge Code	6001051
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CEFTRIAXONE 1GM/NS 100ML BAG

Facility

$493.66

Service Code	HCPCS J0696
Hospital Charge Code	6001036
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$148.10
Rate for Payer: Aetna Commercial	$148.10
Rate for Payer: Aetna Medicare Advantage	$148.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.88
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.05

CEFTRIAXONE 1GM/NS 100ML BAG

Facility

$493.66

Service Code	HCPCS J0696
Hospital Charge Code	6001036
Hospital Revenue Code	636
Min. Negotiated Rate	$74.05
Max. Negotiated Rate	$119.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.05

CEFTRIAXONE 250MG MINIBAG

Facility

$65.00

Hospital Charge Code	60635867
Hospital Revenue Code	636
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CEFTRIAXONE 250MG MINIBAG

Facility

$65.00

Hospital Charge Code	60635867
Hospital Revenue Code	636
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$15.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CEFTRIAXONE 2 GM/NS 100ML BAG

Facility

$653.25

Service Code	HCPCS J0696
Hospital Charge Code	6001044
Hospital Revenue Code	636
Min. Negotiated Rate	$97.99
Max. Negotiated Rate	$158.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.09
Rate for Payer: Qualcare PPO/HMO/WC	$97.99

CEFTRIAXONE 2 GM/NS 100ML BAG

Facility

$653.25

Service Code	HCPCS J0696
Hospital Charge Code	6001044
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$195.97
Rate for Payer: Aetna Commercial	$195.97
Rate for Payer: Aetna Medicare Advantage	$195.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.58
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.09
Rate for Payer: Qualcare PPO/HMO/WC	$97.99

CEFTRIAXONE 500MG(ROCEPHIN) VL

Facility

$198.00

Service Code	HCPCS J0696
Hospital Charge Code	83652555
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna Commercial	$59.40
Rate for Payer: Aetna Medicare Advantage	$59.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.49
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.70

CEFTRIAXONE 500MG(ROCEPHIN) VL

Facility

$198.00

Service Code	HCPCS J0696
Hospital Charge Code	83652555
Hospital Revenue Code	636
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$47.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.70

CEFTRIAXONE INJ 250 MG

Facility

$106.80

Service Code	HCPCS J0696
Hospital Charge Code	6001028
Hospital Revenue Code	636
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$25.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

CEFTRIAXONE INJ 250 MG

Facility

$106.80

Service Code	HCPCS J0696
Hospital Charge Code	6001028
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$32.04
Rate for Payer: Aetna Commercial	$32.04
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.23
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

CEFTRIAXONE INJ 500MG

Facility

$264.68

Service Code	HCPCS J0696
Hospital Charge Code	6007140
Hospital Revenue Code	636
Min. Negotiated Rate	$39.70
Max. Negotiated Rate	$64.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$39.70

CEFTRIAXONE INJ 500MG

Facility

$264.68

Service Code	HCPCS J0696
Hospital Charge Code	6007140
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$79.40
Rate for Payer: Aetna Commercial	$79.40
Rate for Payer: Aetna Medicare Advantage	$79.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.49
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$39.70

CEFTRIAXONE IVBP ISO 1G/50ML

Facility

$215.05

Hospital Charge Code	60629172
Hospital Revenue Code	250
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$107.53
Rate for Payer: Aetna Commercial	$64.52
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.96
Rate for Payer: Oxford Commercial	$107.53
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$107.53

CEFTRIAXONE IVBP ISO 1G/50ML

Facility

$215.05

Hospital Charge Code	60629172
Hospital Revenue Code	250
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

CEFTRIAXONE IVPB ODD DOSE <1G

Facility

$225.95

Hospital Charge Code	60627261
Hospital Revenue Code	250
Min. Negotiated Rate	$29.37
Max. Negotiated Rate	$112.97
Rate for Payer: Aetna Commercial	$67.78
Rate for Payer: Aetna Medicare Advantage	$67.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.62
Rate for Payer: Cigna Commercial	$112.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.37
Rate for Payer: Oxford Commercial	$112.97
Rate for Payer: Qualcare PPO/HMO/WC	$33.89
Rate for Payer: UnitedHealthcare Commercial	$112.97

CEFTRIAXONE IVPB ODD DOSE <1G

Facility

$225.95

Hospital Charge Code	60627261
Hospital Revenue Code	250
Min. Negotiated Rate	$33.89
Max. Negotiated Rate	$33.89
Rate for Payer: Qualcare PPO/HMO/WC	$33.89

CEFUROXIME AXETIL TAB 500MG

Facility

$30.10

Hospital Charge Code	6016349
Hospital Revenue Code	252
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

CEFUROXIME AXETIL TAB 500MG

Facility

$30.10

Hospital Charge Code	6016349
Hospital Revenue Code	252
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

CEFUROXIME SUSP 125MG/5ML

Facility

$3.20

Hospital Charge Code	60627262
Hospital Revenue Code	252
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

CEFUROXIME SUSP 125MG/5ML

Facility

$3.20

Hospital Charge Code	60627262
Hospital Revenue Code	252
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

Know your out-of-pocket cost for care.

All Charges