Heights University Hospital

All Charges

Charge

Type

Setting

Price

DEXAMETHASONE SOD PHOS/4M

Facility

$4.00

Hospital Charge Code	60632811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE SPR 4% 25GM

Facility

$122.90

Hospital Charge Code	6001747
Hospital Revenue Code	251
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$36.87
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.98
Rate for Payer: Oxford Commercial	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$61.45

DEXAMETHASONE SPR 4% 25GM

Facility

$122.90

Hospital Charge Code	6001747
Hospital Revenue Code	251
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

DEXAMETHASONE SUPPRESSION

Facility

$504.99

Service Code	HCPCS 80420
Hospital Charge Code	38472432
Hospital Revenue Code	301
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

DEXAMETHASONE SUPPRESSION

Facility

$504.99

Service Code	HCPCS 80420
Hospital Charge Code	38472432
Hospital Revenue Code	301
Min. Negotiated Rate	$65.65
Max. Negotiated Rate	$593.13
Rate for Payer: Aetna Commercial	$524.49
Rate for Payer: Aetna Medicare Advantage	$161.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$593.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$593.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$161.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$593.13
Rate for Payer: Cigna Commercial	$161.88
Rate for Payer: Cigna Medicare Advantage	$80.94
Rate for Payer: Clover Medicare Advantage	$153.79
Rate for Payer: EmblemHealth Commercial	$485.64
Rate for Payer: Humana Medicare Advantage	$166.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$171.59
Rate for Payer: Wellcare Medicare Advantage	$161.88

DEXAMETHASONE VL 10ML

Facility

$14.00

Service Code	HCPCS J1095
Hospital Charge Code	6012439
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

DEXAMETHASONE VL 10ML

Facility

$14.00

Service Code	HCPCS J1095
Hospital Charge Code	6012439
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$7.00

DEXAMETHASONE VL 10ML

Facility

$3.20

Hospital Charge Code	6022396
Hospital Revenue Code	250
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

DEXAMETHASONE VL 10ML

Facility

$3.20

Hospital Charge Code	6022396
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

DEXAMETHASONE VL 4MG/ML 5ML

Facility

$3.85

Hospital Charge Code	6023261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

DEXAMETHASONE VL 4MG/ML 5ML

Facility

$3.85

Hospital Charge Code	6023261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

DEXAMETHASONE VL ML

Facility

$10.90

Hospital Charge Code	6015051
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

DEXAMETHASONE VL ML

Facility

$10.90

Hospital Charge Code	6015051
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

DEXAMETHASON OPH OIN .05% 3.5G

Facility

$21.15

Hospital Charge Code	6001721
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

DEXAMETHASON OPH OIN .05% 3.5G

Facility

$21.15

Hospital Charge Code	6001721
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

DEXEMEDETOMIDEINE100MCG/ML 2ML

Facility

$253.65

Hospital Charge Code	6063943344
Hospital Revenue Code	250
Min. Negotiated Rate	$38.05
Max. Negotiated Rate	$38.05
Rate for Payer: Qualcare PPO/HMO/WC	$38.05

DEXEMEDETOMIDEINE100MCG/ML 2ML

Facility

$253.65

Hospital Charge Code	6063943344
Hospital Revenue Code	250
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$126.83
Rate for Payer: Aetna Commercial	$76.09
Rate for Payer: Aetna Medicare Advantage	$76.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.68
Rate for Payer: Cigna Commercial	$126.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.97
Rate for Payer: Oxford Commercial	$126.83
Rate for Payer: Qualcare PPO/HMO/WC	$38.05
Rate for Payer: UnitedHealthcare Commercial	$126.83

DEX FIBERTAK KIT

Facility

$1,375.00

Hospital Charge Code	270682059
Hospital Revenue Code	272
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$412.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.75
Rate for Payer: Oxford Commercial	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Commercial	$687.50

DEX FIBERTAK KIT

Facility

$1,375.00

Hospital Charge Code	270682059
Hospital Revenue Code	272
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

DEXMEDETOMIDEINE HCL 100MCG/ML

Facility

$194.17

Service Code	NDC 409163802
Hospital Charge Code	6063943337
Hospital Revenue Code	250
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$29.13
Rate for Payer: Qualcare PPO/HMO/WC	$29.13

DEXMEDETOMIDEINE HCL 100MCG/ML

Facility

$194.17

Service Code	NDC 409163802
Hospital Charge Code	6063943337
Hospital Revenue Code	250
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$97.08
Rate for Payer: Aetna Commercial	$58.25
Rate for Payer: Aetna Medicare Advantage	$58.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.51
Rate for Payer: Cigna Commercial	$97.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.24
Rate for Payer: Oxford Commercial	$97.08
Rate for Payer: Qualcare PPO/HMO/WC	$29.13
Rate for Payer: UnitedHealthcare Commercial	$97.08

DEXMEDETOMIDINE 100 MCG/ML 2ML

Facility

$79.20

Hospital Charge Code	60630215
Hospital Revenue Code	250
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

DEXMEDETOMIDINE 100 MCG/ML 2ML

Facility

$79.20

Hospital Charge Code	60630215
Hospital Revenue Code	250
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna Commercial	$23.76
Rate for Payer: Aetna Medicare Advantage	$23.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.20
Rate for Payer: Cigna Commercial	$39.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.30
Rate for Payer: Oxford Commercial	$39.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
Rate for Payer: UnitedHealthcare Commercial	$39.60

DEXMEDETOMIDINE 400 MCG/ML 100

Facility

$280.60

Service Code	NDC 409166020
Hospital Charge Code	60630214
Hospital Revenue Code	250
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$140.30
Rate for Payer: Aetna Commercial	$84.18
Rate for Payer: Aetna Medicare Advantage	$84.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.55
Rate for Payer: Cigna Commercial	$140.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Oxford Commercial	$140.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.09
Rate for Payer: UnitedHealthcare Commercial	$140.30

DEXMEDETOMIDINE 400 MCG/ML 100

Facility

$280.60

Service Code	NDC 409166020
Hospital Charge Code	60630214
Hospital Revenue Code	250
Min. Negotiated Rate	$42.09
Max. Negotiated Rate	$42.09
Rate for Payer: Qualcare PPO/HMO/WC	$42.09

Know your out-of-pocket cost for care.

All Charges