Heights University Hospital

All Charges

Charge

Type

Setting

Price

DOXYCYCLINE HYCLATE/100MG

Facility

$3.00

Hospital Charge Code	60632907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/100MG

Facility

$7.00

Hospital Charge Code	60632905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

DOXYCYCLINE HYCLATE/100MG

Facility

$7.00

Hospital Charge Code	60632905
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DOXYCYCLINE HYCLATE/100MG

Facility

$3.00

Hospital Charge Code	60632907
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 HYCLATE 100 MG TAB

Facility

$9.45

Service Code	NDC 69095050
Hospital Charge Code	6002083
Hospital Revenue Code	251
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.41
Rate for Payer: Cigna Commercial	$4.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.23
Rate for Payer: Oxford Commercial	$4.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.42
Rate for Payer: UnitedHealthcare Commercial	$4.72

DOXYCYCLINE HYCLATE 100 MG TAB

Facility

$9.45

Service Code	NDC 69095050
Hospital Charge Code	6002083
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.42

DOXYCYCLINE HYCLATE 100MG TAB

Facility

$19.78

Hospital Charge Code	60630236
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

DOXYCYCLINE HYCLATE 100MG TAB

Facility

$19.78

Hospital Charge Code	60630236
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$9.89
Rate for Payer: Aetna Commercial	$5.93
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.57
Rate for Payer: Oxford Commercial	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$9.89

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632906
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632904
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 HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632906
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 HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632904
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DOXYCYCLINE HYCLATE/50MG

Facility

$3.00

Hospital Charge Code	60632903
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 HYCLATE 50 MG CAP

Facility

$4.85

Hospital Charge Code	60627318
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

DOXYCYCLINE HYCLATE 50 MG CAP

Facility

$4.85

Hospital Charge Code	60627318
Hospital Revenue Code	251
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

DOXYCYCLINE IVPB 200MG/D5W250M

Facility

$208.00

Hospital Charge Code	60627317
Hospital Revenue Code	250
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

DOXYCYCLINE IVPB 200MG/D5W250M

Facility

$208.00

Hospital Charge Code	60627317
Hospital Revenue Code	250
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$104.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$104.00

DOXYCYLINE HYCLATE 100MG ORAL

Facility

$15.11

Hospital Charge Code	606361052
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

DOXYCYLINE HYCLATE 100MG ORAL

Facility

$15.11

Hospital Charge Code	606361052
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$7.55
Rate for Payer: Aetna Commercial	$4.53
Rate for Payer: Aetna Medicare Advantage	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

DPD GENE MUTATION

Facility

$460.22

Service Code	HCPCS 81400
Hospital Charge Code	397080008
Hospital Revenue Code	306
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$234.35
Rate for Payer: Aetna Commercial	$207.23
Rate for Payer: Aetna Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.35
Rate for Payer: Cigna Commercial	$63.96
Rate for Payer: Cigna Medicare Advantage	$31.98
Rate for Payer: Clover Medicare Advantage	$60.76
Rate for Payer: EmblemHealth Commercial	$191.88
Rate for Payer: Humana Medicare Advantage	$65.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.03
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$63.96
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$67.80
Rate for Payer: Wellcare Medicare Advantage	$63.96

DPD GENE MUTATION

Facility

$460.22

Service Code	HCPCS 81400
Hospital Charge Code	397080008
Hospital Revenue Code	306
Min. Negotiated Rate	$69.03
Max. Negotiated Rate	$69.03
Rate for Payer: Qualcare PPO/HMO/WC	$69.03

DRAIN ABRAMSON TRIPLE LUMEN

Facility

$145.50

Hospital Charge Code	270645146
Hospital Revenue Code	272
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$21.82
Rate for Payer: Qualcare PPO/HMO/WC	$21.82

DRAIN ABRAMSON TRIPLE LUMEN

Facility

$145.50

Hospital Charge Code	270645146
Hospital Revenue Code	272
Min. Negotiated Rate	$18.91
Max. Negotiated Rate	$72.75
Rate for Payer: Aetna Commercial	$43.65
Rate for Payer: Aetna Medicare Advantage	$43.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.10
Rate for Payer: Cigna Commercial	$72.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.91
Rate for Payer: Oxford Commercial	$72.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.82
Rate for Payer: UnitedHealthcare Commercial	$72.75

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349
Hospital Revenue Code	272
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$13.11
Rate for Payer: Cigna Medicare Advantage	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$51.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$51.50

Know your out-of-pocket cost for care.

All Charges