Heights University Hospital

All Charges

Charge

Type

Setting

Price

DABIGATRAN ETEX MESYLAT 75 CAP

Facility

$42.14

Service Code	NDC 597035556
Hospital Charge Code	60630062
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

DABIGATRAN ETEX MESYLAT 75 CAP

Facility

$42.14

Service Code	NDC 597035556
Hospital Charge Code	60630062
Hospital Revenue Code	250
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$21.07
Rate for Payer: Aetna Commercial	$12.64
Rate for Payer: Aetna Medicare Advantage	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.75
Rate for Payer: Cigna Commercial	$21.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.48
Rate for Payer: Oxford Commercial	$21.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$21.07

DACARBAZINE 200 MG INJ

Facility

$131.92

Service Code	HCPCS J9130
Hospital Charge Code	6001598
Hospital Revenue Code	636
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$31.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.79

DACARBAZINE 200 MG INJ

Facility

$131.92

Service Code	HCPCS J9130
Hospital Charge Code	6001598
Hospital Revenue Code	636
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$39.58
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$39.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.64
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.79

DACRIOSE 8 FL OZ

Facility

$53.80

Hospital Charge Code	6008445
Hospital Revenue Code	252
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

DACRIOSE 8 FL OZ

Facility

$53.80

Hospital Charge Code	6008445
Hospital Revenue Code	252
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

DACRIOSE OPHTH/118ML

Facility

$15.00

Hospital Charge Code	60632775
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

DACRIOSE OPHTH/118ML

Facility

$15.00

Hospital Charge Code	60632775
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: UnitedHealthcare Commercial	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

DACTINOMYCIN 0.5 MG INJ

Facility

$4,997.93

Service Code	HCPCS J9120
Hospital Charge Code	60627375
Hospital Revenue Code	636
Min. Negotiated Rate	$749.69
Max. Negotiated Rate	$1,209.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,209.50
Rate for Payer: Qualcare PPO/HMO/WC	$749.69

DACTINOMYCIN 0.5 MG INJ

Facility

$4,997.93

Service Code	HCPCS J9120
Hospital Charge Code	60627375
Hospital Revenue Code	636
Min. Negotiated Rate	$749.69
Max. Negotiated Rate	$1,499.38
Rate for Payer: Aetna Commercial	$1,499.38
Rate for Payer: Aetna Medicare Advantage	$1,499.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,274.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,274.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,274.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,209.50
Rate for Payer: Qualcare PPO/HMO/WC	$749.69

DACTINOMYCIN INJ VL 0.5MG

Facility

$139.00

Hospital Charge Code	6001606
Hospital Revenue Code	250
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

DACTINOMYCIN INJ VL 0.5MG

Facility

$139.00

Hospital Charge Code	6001606
Hospital Revenue Code	250
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.07
Rate for Payer: Oxford Commercial	$69.50
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Commercial	$69.50

DAIN HUBLESS BLAKE 15FR

Facility

$3,209.20

Hospital Charge Code	270657433
Hospital Revenue Code	278
Min. Negotiated Rate	$481.38
Max. Negotiated Rate	$1,604.60
Rate for Payer: Aetna Commercial	$962.76
Rate for Payer: Aetna Medicare Advantage	$962.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$818.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$818.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$818.35
Rate for Payer: Cigna Commercial	$1,604.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$776.63
Rate for Payer: Qualcare PPO/HMO/WC	$481.38

DAIN HUBLESS BLAKE 15FR

Facility

$3,209.20

Hospital Charge Code	270657433
Hospital Revenue Code	278
Min. Negotiated Rate	$481.38
Max. Negotiated Rate	$776.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$776.63
Rate for Payer: Qualcare PPO/HMO/WC	$481.38

DAKIN'S 0.25% SOL

Facility

$115.58

Service Code	NDC 436093616
Hospital Charge Code	60629895
Hospital Revenue Code	250
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$57.79
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$34.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.47
Rate for Payer: Cigna Commercial	$57.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.03
Rate for Payer: Oxford Commercial	$57.79
Rate for Payer: Qualcare PPO/HMO/WC	$17.34
Rate for Payer: UnitedHealthcare Commercial	$57.79

DAKIN'S 0.25% SOL

Facility

$115.58

Service Code	NDC 436093616
Hospital Charge Code	60629895
Hospital Revenue Code	250
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Qualcare PPO/HMO/WC	$17.34

DAKIN'S SOL 0.125%

Facility

$38.20

Hospital Charge Code	60635752
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.73

DAKIN'S SOL 0.125%

Facility

$38.20

Hospital Charge Code	60635752
Hospital Revenue Code	250
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$19.10
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.74
Rate for Payer: Cigna Commercial	$19.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.97
Rate for Payer: Oxford Commercial	$19.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$19.10

DAKIN'S SOLUTION 0.125%

Facility

$39.00

Hospital Charge Code	60635681
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$19.50
Rate for Payer: Oxford Commercial	$19.50
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$19.50

DAKIN'S SOLUTION 0.125%

Facility

$39.00

Hospital Charge Code	60635681
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

DAKINS SOLUTION 0.125%

Facility

$113.90

Service Code	NDC 436067216
Hospital Charge Code	606350997
Hospital Revenue Code	250
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$17.09
Rate for Payer: Qualcare PPO/HMO/WC	$17.09

DAKINS SOLUTION 0.125%

Facility

$113.90

Service Code	NDC 436067216
Hospital Charge Code	606350997
Hospital Revenue Code	250
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$56.95
Rate for Payer: Aetna Commercial	$34.17
Rate for Payer: Aetna Medicare Advantage	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.04
Rate for Payer: Cigna Commercial	$56.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.81
Rate for Payer: Oxford Commercial	$56.95
Rate for Payer: Qualcare PPO/HMO/WC	$17.09
Rate for Payer: UnitedHealthcare Commercial	$56.95

DAKIN'S SOLUTION 0.5%

Facility

$39.00

Hospital Charge Code	60635682
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$19.50

DAKIN'S SOLUTION 0.5%

Facility

$39.00

Hospital Charge Code	60635682
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

DAKIN'S TOPICAL 0.5% SOL

Facility

$115.58

Service Code	NDC 436094616
Hospital Charge Code	60629896
Hospital Revenue Code	250
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$57.79
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$34.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.47
Rate for Payer: Cigna Commercial	$57.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.03
Rate for Payer: Oxford Commercial	$57.79
Rate for Payer: Qualcare PPO/HMO/WC	$17.34
Rate for Payer: UnitedHealthcare Commercial	$57.79

Know your out-of-pocket cost for care.

All Charges