Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

DINOPROSTONE GEL CERVICAL 3GM

Facility

$252.00

Hospital Charge Code	6007702
Hospital Revenue Code	250
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$75.60
Rate for Payer: Aetna Medicare Advantage	$75.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.26
Rate for Payer: Cigna Commercial	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.76
Rate for Payer: Oxford Commercial	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
Rate for Payer: UnitedHealthcare Commercial	$126.00

DINOPROSTONE GEL CERVICAL 3GM

Facility

$252.00

Hospital Charge Code	6007702
Hospital Revenue Code	250
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

DINOPROSTONE INSERT VAG 10MG

Facility

$1,717.65

Hospital Charge Code	60628280
Hospital Revenue Code	250
Min. Negotiated Rate	$257.65
Max. Negotiated Rate	$257.65
Rate for Payer: Qualcare PPO/HMO/WC	$257.65

DINOPROSTONE INSERT VAG 10MG

Facility

$1,717.65

Hospital Charge Code	60628280
Hospital Revenue Code	250
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$858.83
Rate for Payer: Aetna Commercial	$515.29
Rate for Payer: Aetna Medicare Advantage	$515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.00
Rate for Payer: Cigna Commercial	$858.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.29
Rate for Payer: Oxford Commercial	$858.83
Rate for Payer: Qualcare PPO/HMO/WC	$257.65
Rate for Payer: UnitedHealthcare Commercial	$858.83

DINOPROSTONE SUPP 20MG

Facility

$913.95

Hospital Charge Code	6009476
Hospital Revenue Code	251
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$456.98
Rate for Payer: Aetna Commercial	$274.19
Rate for Payer: Aetna Medicare Advantage	$274.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.06
Rate for Payer: Cigna Commercial	$456.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.81
Rate for Payer: Oxford Commercial	$456.98
Rate for Payer: Qualcare PPO/HMO/WC	$137.09
Rate for Payer: UnitedHealthcare Commercial	$456.98

DINOPROSTONE SUPP 20MG

Facility

$913.95

Hospital Charge Code	6009476
Hospital Revenue Code	251
Min. Negotiated Rate	$137.09
Max. Negotiated Rate	$137.09
Rate for Payer: Qualcare PPO/HMO/WC	$137.09

DINOPROST TROMETH INJ 5MG/ML

Facility

$73.00

Hospital Charge Code	6001960
Hospital Revenue Code	250
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

DINOPROST TROMETH INJ 5MG/ML

Facility

$73.00

Hospital Charge Code	6001960
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

DIOCTO/150MG/15ML

Facility

$34.00

Hospital Charge Code	60632856
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

DIOCTO/150MG/15ML

Facility

$34.00

Hospital Charge Code	60632856
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

DIOCTO-C/480ML

Facility

$3.00

Hospital Charge Code	60632857
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIOCTO-C/480ML

Facility

$3.00

Hospital Charge Code	60632857
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

DIOCTOSYR/16OZ/60MG/15ML

Facility

$23.00

Hospital Charge Code	60634640
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

DIOCTOSYR/16OZ/60MG/15ML

Facility

$23.00

Hospital Charge Code	60634640
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

DIOVAN 160MG TAB

Facility

$3.00

Hospital Charge Code	60635406
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIOVAN 160MG TAB

Facility

$3.00

Hospital Charge Code	60635406
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

DIOVAN 160MG TAB

Facility

$34.91

Service Code	NDC 93743398
Hospital Charge Code	6063943096
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.24
Rate for Payer: Qualcare PPO/HMO/WC	$5.24

DIOVAN 160MG TAB

Facility

$34.91

Service Code	NDC 93743398
Hospital Charge Code	6063943096
Hospital Revenue Code	250
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$17.45
Rate for Payer: Aetna Commercial	$10.47
Rate for Payer: Aetna Medicare Advantage	$10.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.90
Rate for Payer: Cigna Commercial	$17.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.54
Rate for Payer: Oxford Commercial	$17.45
Rate for Payer: Qualcare PPO/HMO/WC	$5.24
Rate for Payer: UnitedHealthcare Commercial	$17.45

DIOVAN,320MG,TAB

Facility

$4.00

Hospital Charge Code	60635416
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIOVAN,320MG,TAB

Facility

$4.00

Hospital Charge Code	60635416
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

DIOVAN 40MG TAB

Facility

$2.00

Hospital Charge Code	60635404
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

DIOVAN 40MG TAB

Facility

$27.20

Service Code	NDC 93743156
Hospital Charge Code	6063943097
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.08

DIOVAN 40MG TAB

Facility

$2.00

Hospital Charge Code	60635404
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

DIOVAN 40MG TAB

Facility

$27.20

Service Code	NDC 93743156
Hospital Charge Code	6063943097
Hospital Revenue Code	250
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare Advantage	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.94
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.54
Rate for Payer: Oxford Commercial	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.08
Rate for Payer: UnitedHealthcare Commercial	$13.60

Know your out-of-pocket cost for care.

All Charges