Heights University Hospital

All Charges

Charge

Type

Setting

Price

DAKIN'S TOPICAL 0.5% SOL

Facility

$115.58

Service Code	NDC 436094616
Hospital Charge Code	60629896
Hospital Revenue Code	250
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Qualcare PPO/HMO/WC	$17.34

DALBAVANCIN 500MG VIAL

Facility

$11,979.60

Service Code	HCPCS J0875
Hospital Charge Code	606390045
Hospital Revenue Code	636
Min. Negotiated Rate	$1,796.94
Max. Negotiated Rate	$2,899.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.94

DALBAVANCIN 500MG VIAL

Facility

$11,979.60

Service Code	HCPCS J0875
Hospital Charge Code	606390045
Hospital Revenue Code	636
Min. Negotiated Rate	$1,796.94
Max. Negotiated Rate	$3,593.88
Rate for Payer: Aetna Commercial	$3,593.88
Rate for Payer: Aetna Medicare Advantage	$3,593.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,054.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,054.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,054.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.94

DALIRESP 500MCG

Facility

$828.00

Hospital Charge Code	60635808
Hospital Revenue Code	250
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$124.20
Rate for Payer: Qualcare PPO/HMO/WC	$124.20

DALIRESP 500MCG

Facility

$828.00

Hospital Charge Code	60635808
Hospital Revenue Code	250
Min. Negotiated Rate	$107.64
Max. Negotiated Rate	$414.00
Rate for Payer: Aetna Commercial	$248.40
Rate for Payer: Aetna Medicare Advantage	$248.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.14
Rate for Payer: Cigna Commercial	$414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$414.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.20
Rate for Payer: UnitedHealthcare Commercial	$414.00

DALTEPARIN INJ 10,000U/1 ML

Facility

$405.00

Hospital Charge Code	60628985
Hospital Revenue Code	250
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Oxford Commercial	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$202.50

DALTEPARIN INJ 10,000U/1 ML

Facility

$405.00

Hospital Charge Code	60628985
Hospital Revenue Code	250
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

DALTEPARIN INJ 10000U/1ML

Facility

$201.00

Hospital Charge Code	60629253
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Aetna Medicare Advantage	$60.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.26
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.13
Rate for Payer: Oxford Commercial	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Commercial	$100.50

DALTEPARIN INJ 10000U/1ML

Facility

$201.00

Hospital Charge Code	60629253
Hospital Revenue Code	250
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

DALTEPARIN INJ 2500U/0.2ML

Facility

$1,070.00

Hospital Charge Code	60629158
Hospital Revenue Code	250
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

DALTEPARIN INJ 2500U/0.2ML

Facility

$1,070.00

Hospital Charge Code	60629158
Hospital Revenue Code	250
Min. Negotiated Rate	$139.10
Max. Negotiated Rate	$535.00
Rate for Payer: Oxford Commercial	$535.00
Rate for Payer: Aetna Commercial	$321.00
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.10
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$535.00

DALTEPARIN INJ 5,000U/0.2 ML

Facility

$202.50

Hospital Charge Code	60628984
Hospital Revenue Code	250
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna Commercial	$60.75
Rate for Payer: Aetna Medicare Advantage	$60.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.64
Rate for Payer: Cigna Commercial	$101.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.32
Rate for Payer: Oxford Commercial	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$30.38
Rate for Payer: UnitedHealthcare Commercial	$101.25

DALTEPARIN INJ 5,000U/0.2 ML

Facility

$202.50

Hospital Charge Code	60628984
Hospital Revenue Code	250
Min. Negotiated Rate	$30.38
Max. Negotiated Rate	$30.38
Rate for Payer: Qualcare PPO/HMO/WC	$30.38

DANAZOL 100 MG CAP

Facility

$36.45

Service Code	NDC 555063402
Hospital Charge Code	60628212
Hospital Revenue Code	250
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$18.23

DANAZOL 100 MG CAP

Facility

$36.45

Service Code	NDC 555063402
Hospital Charge Code	60628212
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

DANOCRINE

Facility

$13.00

Hospital Charge Code	60634473
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

DANOCRINE

Facility

$13.00

Hospital Charge Code	60634473
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

DANTRIUM/100MG

Facility

$14.54

Service Code	NDC 115443301
Hospital Charge Code	60634475
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

DANTRIUM/100MG

Facility

$14.54

Service Code	NDC 115443301
Hospital Charge Code	60634475
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$4.36
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.89
Rate for Payer: Oxford Commercial	$7.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$7.27

DANTRIUM/25MG

Facility

$8.58

Service Code	NDC 42023012401
Hospital Charge Code	60634474
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$4.29

DANTRIUM/25MG

Facility

$8.58

Service Code	NDC 42023012401
Hospital Charge Code	60634474
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

DANTRIUM IV

Facility

$324.00

Hospital Charge Code	60635122
Hospital Revenue Code	250
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$162.00

DANTRIUM IV

Facility

$324.00

Hospital Charge Code	60635122
Hospital Revenue Code	250
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

DANTROLENE 20 MG INJ

Facility

$712.68

Service Code	NDC 42023012306
Hospital Charge Code	60627483
Hospital Revenue Code	250
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$356.34
Rate for Payer: Aetna Commercial	$213.80
Rate for Payer: Aetna Medicare Advantage	$213.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.73
Rate for Payer: Cigna Commercial	$356.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.65
Rate for Payer: Oxford Commercial	$356.34
Rate for Payer: Qualcare PPO/HMO/WC	$106.90
Rate for Payer: UnitedHealthcare Commercial	$356.34

DANTROLENE 20 MG INJ

Facility

$712.68

Service Code	NDC 42023012306
Hospital Charge Code	60627483
Hospital Revenue Code	250
Min. Negotiated Rate	$106.90
Max. Negotiated Rate	$106.90
Rate for Payer: Qualcare PPO/HMO/WC	$106.90

Know your out-of-pocket cost for care.

All Charges