Heights University Hospital

All Charges

Charge

Type

Setting

Price

DEXTRAN 40/5%/500CC

Facility

$238.00

Hospital Charge Code	60635847
Hospital Revenue Code	258
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.70

DEXTRAN 40/5%/500CC

Facility

$238.00

Hospital Charge Code	60635847
Hospital Revenue Code	258
Min. Negotiated Rate	$30.94
Max. Negotiated Rate	$119.00
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna Medicare Advantage	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.69
Rate for Payer: Cigna Commercial	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.94
Rate for Payer: Oxford Commercial	$119.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.70
Rate for Payer: UnitedHealthcare Commercial	$119.00

DEXTRAN 70 0.9% NACL 500ML

Facility

$89.00

Hospital Charge Code	6014179
Hospital Revenue Code	258
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

DEXTRAN 70 0.9% NACL 500ML

Facility

$79.40

Hospital Charge Code	6016141
Hospital Revenue Code	258
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$39.70
Rate for Payer: Aetna Commercial	$23.82
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$39.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Oxford Commercial	$39.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.91
Rate for Payer: UnitedHealthcare Commercial	$39.70

DEXTRAN 70 0.9% NACL 500ML

Facility

$89.00

Hospital Charge Code	6014179
Hospital Revenue Code	258
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

DEXTRAN 70 0.9% NACL 500ML

Facility

$79.40

Hospital Charge Code	6016141
Hospital Revenue Code	258
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$11.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

DEXTRAN 70 32% 100ML

Facility

$326.40

Hospital Charge Code	6001796
Hospital Revenue Code	258
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$48.96
Rate for Payer: Qualcare PPO/HMO/WC	$48.96

DEXTRAN 70 32% 100ML

Facility

$326.40

Hospital Charge Code	6001796
Hospital Revenue Code	258
Min. Negotiated Rate	$42.43
Max. Negotiated Rate	$163.20
Rate for Payer: Aetna Commercial	$97.92
Rate for Payer: Aetna Medicare Advantage	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.23
Rate for Payer: Cigna Commercial	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.43
Rate for Payer: Oxford Commercial	$163.20
Rate for Payer: Qualcare PPO/HMO/WC	$48.96
Rate for Payer: UnitedHealthcare Commercial	$163.20

DEXTRAN 70/6%/500CC

Facility

$238.00

Hospital Charge Code	60635848
Hospital Revenue Code	258
Min. Negotiated Rate	$30.94
Max. Negotiated Rate	$119.00
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna Medicare Advantage	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.69
Rate for Payer: Cigna Commercial	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.94
Rate for Payer: Oxford Commercial	$119.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.70
Rate for Payer: UnitedHealthcare Commercial	$119.00

DEXTRAN 70/6%/500CC

Facility

$238.00

Hospital Charge Code	60635848
Hospital Revenue Code	258
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.70

DEXTRAN 70 6%-NACL 0.9% INJ

Facility

$261.95

Hospital Charge Code	60627906
Hospital Revenue Code	636
Min. Negotiated Rate	$39.29
Max. Negotiated Rate	$130.97
Rate for Payer: Aetna Commercial	$78.58
Rate for Payer: Aetna Medicare Advantage	$78.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.80
Rate for Payer: Cigna Commercial	$130.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.39
Rate for Payer: Qualcare PPO/HMO/WC	$39.29

DEXTRAN 70 6%-NACL 0.9% INJ

Facility

$261.95

Hospital Charge Code	60627906
Hospital Revenue Code	636
Min. Negotiated Rate	$39.29
Max. Negotiated Rate	$63.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.39
Rate for Payer: Qualcare PPO/HMO/WC	$39.29

DEXTRANOMER PACK 4GM

Facility

$34.60

Hospital Charge Code	6001804
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

DEXTRANOMER PACK 4GM

Facility

$34.60

Hospital Charge Code	6001804
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

DEXTRANOMER PACKET

Facility

$52.50

Hospital Charge Code	60628445
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

DEXTRANOMER PACKET

Facility

$52.50

Hospital Charge Code	60628445
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

DEXTROAMPHETAMINE TAB 5MG

Facility

$19.25

Hospital Charge Code	60629057
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

DEXTROAMPHETAMINE TAB 5MG

Facility

$19.25

Hospital Charge Code	60629057
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

DEXTROMETHORP-GUAIFEN 5-100MG

Facility

$18.56

Service Code	NDC 121127600
Hospital Charge Code	60629011
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

DEXTROMETHORP-GUAIFEN 5-100MG

Facility

$18.56

Service Code	NDC 121127600
Hospital Charge Code	60629011
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna Commercial	$5.57
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.73
Rate for Payer: Cigna Commercial	$9.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.41
Rate for Payer: Oxford Commercial	$9.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.78
Rate for Payer: UnitedHealthcare Commercial	$9.28

DEXTROSE 10% 1000cc INJ

Facility

$5.75

Hospital Charge Code	270650082
Hospital Revenue Code	258
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

DEXTROSE 10% 1000cc INJ

Facility

$5.75

Hospital Charge Code	270650082
Hospital Revenue Code	258
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$2.88

DEXTROSE 25% INJ SYRINGE

Facility

$18.56

Service Code	NDC 409177510
Hospital Charge Code	60627955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

DEXTROSE 25% INJ SYRINGE

Facility

$18.56

Service Code	NDC 409177510
Hospital Charge Code	60627955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna Commercial	$5.57
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.73
Rate for Payer: Cigna Commercial	$9.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.41
Rate for Payer: Oxford Commercial	$9.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.78
Rate for Payer: UnitedHealthcare Commercial	$9.28

DEXTROSE 50%/500CC

Facility

$99.29

Service Code	NDC 990793619
Hospital Charge Code	60635845
Hospital Revenue Code	258
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$49.65
Rate for Payer: Aetna Commercial	$29.79
Rate for Payer: Aetna Medicare Advantage	$29.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.32
Rate for Payer: Cigna Commercial	$49.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.91
Rate for Payer: Oxford Commercial	$49.65
Rate for Payer: Qualcare PPO/HMO/WC	$14.89
Rate for Payer: UnitedHealthcare Commercial	$49.65

Know your out-of-pocket cost for care.

All Charges