Heights University Hospital

All Charges

Charge

Type

Setting

Price

DOXERCALCIFEROL 4 MCG/2ML INJ

Facility

$185.59

Service Code	HCPCS J1270
Hospital Charge Code	60629353
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$55.68
Rate for Payer: Aetna Commercial	$55.68
Rate for Payer: Aetna Medicare Advantage	$55.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.33
Rate for Payer: Cigna Commercial	$0.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.91
Rate for Payer: Qualcare PPO/HMO/WC	$27.84

DOXORUBICIN/2MG/1ML

Facility

$1,469.00

Hospital Charge Code	60632900
Hospital Revenue Code	250
Min. Negotiated Rate	$190.97
Max. Negotiated Rate	$734.50
Rate for Payer: Aetna Commercial	$440.70
Rate for Payer: Aetna Medicare Advantage	$440.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$374.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$374.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$374.60
Rate for Payer: Cigna Commercial	$734.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.97
Rate for Payer: Oxford Commercial	$734.50
Rate for Payer: Qualcare PPO/HMO/WC	$220.35
Rate for Payer: UnitedHealthcare Commercial	$734.50

DOXORUBICIN/2MG/1ML

Facility

$1,469.00

Hospital Charge Code	60632900
Hospital Revenue Code	250
Min. Negotiated Rate	$220.35
Max. Negotiated Rate	$220.35
Rate for Payer: Qualcare PPO/HMO/WC	$220.35

DOXORUBICIN 50 MG/25ML INJ

Facility

$446.22

Service Code	HCPCS J9000
Hospital Charge Code	60627379
Hospital Revenue Code	636
Min. Negotiated Rate	$66.93
Max. Negotiated Rate	$107.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.99
Rate for Payer: Qualcare PPO/HMO/WC	$66.93

DOXORUBICIN 50 MG/25ML INJ

Facility

$446.22

Service Code	HCPCS J9000
Hospital Charge Code	60627379
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$133.87
Rate for Payer: Aetna Commercial	$133.87
Rate for Payer: Aetna Medicare Advantage	$133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.79
Rate for Payer: Cigna Commercial	$2.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.99
Rate for Payer: Qualcare PPO/HMO/WC	$66.93

DOXORUBICIN HCL INJ 50MG

Facility

$835.00

Hospital Charge Code	6002075
Hospital Revenue Code	636
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$250.50
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

DOXORUBICIN HCL INJ 50MG

Facility

$835.00

Hospital Charge Code	6002075
Hospital Revenue Code	636
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$202.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

DOXORUBICIN HCL LIPSOME INJ 20

Facility

$2,983.05

Hospital Charge Code	6017909
Hospital Revenue Code	250
Min. Negotiated Rate	$447.46
Max. Negotiated Rate	$447.46
Rate for Payer: Qualcare PPO/HMO/WC	$447.46

DOXORUBICIN HCL LIPSOME INJ 20

Facility

$2,983.05

Hospital Charge Code	6017909
Hospital Revenue Code	250
Min. Negotiated Rate	$387.80
Max. Negotiated Rate	$1,491.53
Rate for Payer: Aetna Commercial	$894.91
Rate for Payer: Aetna Medicare Advantage	$894.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$760.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$760.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$760.68
Rate for Payer: Cigna Commercial	$1,491.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.80
Rate for Payer: Oxford Commercial	$1,491.53
Rate for Payer: Qualcare PPO/HMO/WC	$447.46
Rate for Payer: UnitedHealthcare Commercial	$1,491.53

DOXORUBICIN LIPOSOMAL 2 MG/ML

Facility

$83,869.80

Hospital Charge Code	6063943102
Hospital Revenue Code	636
Min. Negotiated Rate	$12,580.47
Max. Negotiated Rate	$41,934.90
Rate for Payer: Aetna Commercial	$25,160.94
Rate for Payer: Aetna Medicare Advantage	$25,160.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,386.80
Rate for Payer: Cigna Commercial	$41,934.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,296.49
Rate for Payer: Qualcare PPO/HMO/WC	$12,580.47

DOXORUBICIN LIPOSOMAL 2 MG/ML

Facility

$83,869.80

Hospital Charge Code	6063943102
Hospital Revenue Code	636
Min. Negotiated Rate	$12,580.47
Max. Negotiated Rate	$20,296.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,296.49
Rate for Payer: Qualcare PPO/HMO/WC	$12,580.47

DOXORUBICIN LIPOSOME 20MG/10ML

Facility

$8,666.32

Service Code	HCPCS Q2050
Hospital Charge Code	60628766
Hospital Revenue Code	636
Min. Negotiated Rate	$1,299.95
Max. Negotiated Rate	$2,599.90
Rate for Payer: Aetna Commercial	$2,599.90
Rate for Payer: Aetna Medicare Advantage	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,209.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,209.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,209.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,097.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.95

DOXORUBICIN LIPOSOME 20MG/10ML

Facility

$8,666.32

Service Code	HCPCS Q2050
Hospital Charge Code	60628766
Hospital Revenue Code	636
Min. Negotiated Rate	$1,299.95
Max. Negotiated Rate	$2,097.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,097.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.95

DOXY-100/100MG

Facility

$48.00

Hospital Charge Code	60632901
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DOXY-100/100MG

Facility

$48.00

Hospital Charge Code	60632901
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

DOXY-200/200MG

Facility

$15.00

Hospital Charge Code	60632902
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

DOXY-200/200MG

Facility

$15.00

Hospital Charge Code	60632902
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

DOXYCYCLINE 100 MG INJ

Facility

$97.28

Service Code	NDC 63323013013
Hospital Charge Code	6002091
Hospital Revenue Code	250
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$14.59
Rate for Payer: Qualcare PPO/HMO/WC	$14.59

DOXYCYCLINE 100 MG INJ

Facility

$97.28

Service Code	NDC 63323013013
Hospital Charge Code	6002091
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$48.64
Rate for Payer: Aetna Commercial	$29.18
Rate for Payer: Aetna Medicare Advantage	$29.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.65
Rate for Payer: Oxford Commercial	$48.64
Rate for Payer: Qualcare PPO/HMO/WC	$14.59
Rate for Payer: UnitedHealthcare Commercial	$48.64

DOXYCYCLINE 20 MG TAB

Facility

$1.41

Hospital Charge Code	60630118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.71
Rate for Payer: Aetna Commercial	$0.42
Rate for Payer: Aetna Medicare Advantage	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.36
Rate for Payer: Cigna Commercial	$0.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.18
Rate for Payer: Oxford Commercial	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.21
Rate for Payer: UnitedHealthcare Commercial	$0.71

DOXYCYCLINE 20 MG TAB

Facility

$1.41

Hospital Charge Code	60630118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.21

Doxycycline 50mg/5ml oral

Facility

$4.08

Hospital Charge Code	6063943274
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$2.04
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$1.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.04
Rate for Payer: Cigna Commercial	$2.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.53
Rate for Payer: Oxford Commercial	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.61
Rate for Payer: UnitedHealthcare Commercial	$2.04

Doxycycline 50mg/5ml oral

Facility

$4.08

Hospital Charge Code	6063943274
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

DOXYCYCLINE/50MG/UD

Facility

$3.00

Hospital Charge Code	60634664
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

DOXYCYCLINE/50MG/UD

Facility

$3.00

Hospital Charge Code	60634664
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges