Heights University Hospital

All Charges

Charge

Type

Setting

Price

DIMENHYDRINATE SOL 15MG/ML

Facility

$147.85

Hospital Charge Code	6001945
Hospital Revenue Code	251
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$44.35
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.22
Rate for Payer: Oxford Commercial	$73.92
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$73.92

DIMENHYDRINATE SOL 15MG/ML

Facility

$147.85

Hospital Charge Code	6001945
Hospital Revenue Code	251
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

DIMERCAPROL INJ 100MG/ML

Facility

$497.50

Hospital Charge Code	60628176
Hospital Revenue Code	250
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$74.62

DIMERCAPROL INJ 100MG/ML

Facility

$497.50

Hospital Charge Code	60628176
Hospital Revenue Code	250
Min. Negotiated Rate	$64.67
Max. Negotiated Rate	$248.75
Rate for Payer: Aetna Commercial	$149.25
Rate for Payer: Aetna Medicare Advantage	$149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.86
Rate for Payer: Cigna Commercial	$248.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.67
Rate for Payer: Oxford Commercial	$248.75
Rate for Payer: Qualcare PPO/HMO/WC	$74.62
Rate for Payer: UnitedHealthcare Commercial	$248.75

DIMERCAPROL INJ 10% 3ML

Facility

$398.00

Hospital Charge Code	6001952
Hospital Revenue Code	250
Min. Negotiated Rate	$59.70
Max. Negotiated Rate	$59.70
Rate for Payer: Qualcare PPO/HMO/WC	$59.70

DIMERCAPROL INJ 10% 3ML

Facility

$398.00

Hospital Charge Code	6001952
Hospital Revenue Code	250
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$199.00
Rate for Payer: Aetna Commercial	$119.40
Rate for Payer: Aetna Medicare Advantage	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.49
Rate for Payer: Cigna Commercial	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.74
Rate for Payer: Oxford Commercial	$199.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.70
Rate for Payer: UnitedHealthcare Commercial	$199.00

DIMETANE-DX/480ML

Facility

$155.00

Hospital Charge Code	60632850
Hospital Revenue Code	250
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$46.50
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.15
Rate for Payer: Oxford Commercial	$77.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Commercial	$77.50

DIMETANE-DX/480ML

Facility

$155.00

Hospital Charge Code	60632850
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

DIMETAPP/3840ML

Facility

$8.00

Hospital Charge Code	60632854
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

DIMETAPP/3840ML

Facility

$8.00

Hospital Charge Code	60632854
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

DIMETAPP/480ML

Facility

$72.00

Hospital Charge Code	60632852
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

DIMETAPP/480ML

Facility

$72.00

Hospital Charge Code	60632852
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

DIMETAPP/5ML

Facility

$6.00

Hospital Charge Code	60632853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

DIMETAPP/5ML

Facility

$6.00

Hospital Charge Code	60632853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DIMETAPP EXTENTAB/TAB

Facility

$3.00

Hospital Charge Code	60632855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

DIMETAPP EXTENTAB/TAB

Facility

$3.00

Hospital Charge Code	60632855
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIMETAPP/TAB

Facility

$3.00

Hospital Charge Code	60632851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

DIMETAPP/TAB

Facility

$3.00

Hospital Charge Code	60632851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIMRETIC PANEL, URINE

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	3035115B
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

DIMRETIC PANEL, URINE

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	3035115A
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

DIMRETIC PANEL, URINE

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	3035115B
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

DIMRETIC PANEL, URINE

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	3035115A
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

DINOPROSTONE 10MG VAGINAL INST

Facility

$2,462.38

Service Code	NDC 55566280001
Hospital Charge Code	60632287
Hospital Revenue Code	250
Min. Negotiated Rate	$320.11
Max. Negotiated Rate	$1,231.19
Rate for Payer: Aetna Commercial	$738.71
Rate for Payer: Aetna Medicare Advantage	$738.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$627.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$627.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$627.91
Rate for Payer: Cigna Commercial	$1,231.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.11
Rate for Payer: Oxford Commercial	$1,231.19
Rate for Payer: Qualcare PPO/HMO/WC	$369.36
Rate for Payer: UnitedHealthcare Commercial	$1,231.19

DINOPROSTONE 10MG VAGINAL INST

Facility

$2,462.38

Service Code	NDC 55566280001
Hospital Charge Code	60632287
Hospital Revenue Code	250
Min. Negotiated Rate	$369.36
Max. Negotiated Rate	$369.36
Rate for Payer: Qualcare PPO/HMO/WC	$369.36

DINOPROSTONE 20 MG SUP

Facility

$5,885.20

Hospital Charge Code	60628281
Hospital Revenue Code	250
Min. Negotiated Rate	$882.78
Max. Negotiated Rate	$882.78
Rate for Payer: Qualcare PPO/HMO/WC	$882.78

Know your out-of-pocket cost for care.

All Charges