Heights University Hospital

All Charges

Charge

Type

Setting

Price

AZACITIDINE 100 MG REC

Facility

$4,705.34

Service Code	HCPCS J9025
Hospital Charge Code	60629945
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1,411.60
Rate for Payer: Aetna Commercial	$1,411.60
Rate for Payer: Aetna Medicare Advantage	$1,411.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.86
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.69
Rate for Payer: Qualcare PPO/HMO/WC	$705.80

AZACITIDINE 100 MG REC

Facility

$2,941.15

Hospital Charge Code	60629945A
Hospital Revenue Code	636
Min. Negotiated Rate	$441.17
Max. Negotiated Rate	$1,470.58
Rate for Payer: Aetna Commercial	$882.35
Rate for Payer: Aetna Medicare Advantage	$882.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$749.99
Rate for Payer: Cigna Commercial	$1,470.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.76
Rate for Payer: Qualcare PPO/HMO/WC	$441.17

AZACITIDINE 1 MG J9025

Facility

$32.38

Hospital Charge Code	60639251T
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$7.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

AZACITIDINE 1 MG J9025

Facility

$32.38

Hospital Charge Code	60639251T
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$16.19
Rate for Payer: Aetna Commercial	$9.71
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.26
Rate for Payer: Cigna Commercial	$16.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

AZACTAM 1GM/50ML PREMIXED

Facility

$63.00

Hospital Charge Code	60635013
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

AZACTAM 1GM/50ML PREMIXED

Facility

$63.00

Hospital Charge Code	60635013
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.19
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$31.50

AZACTAM 2G/50ML

Facility

$112.00

Hospital Charge Code	60635023
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

AZACTAM 2G/50ML

Facility

$112.00

Hospital Charge Code	60635023
Hospital Revenue Code	250
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$33.60
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.56
Rate for Payer: Oxford Commercial	$56.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$56.00

AZACTAM/2GM

Facility

$110.00

Hospital Charge Code	60632519
Hospital Revenue Code	250
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

AZACTAM/2GM

Facility

$110.00

Hospital Charge Code	60632519
Hospital Revenue Code	250
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

AZACTAM/500MG

Facility

$34.00

Hospital Charge Code	60632518
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

AZACTAM/500MG

Facility

$34.00

Hospital Charge Code	60632518
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

AZATHIOPRINE 50 MG TAB

Facility

$9.65

Service Code	HCPCS J7500
Hospital Charge Code	60627364
Hospital Revenue Code	636
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$0.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

AZATHIOPRINE 50 MG TAB

Facility

$9.65

Service Code	HCPCS J7500
Hospital Charge Code	60627364
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

AZATHIOPRINE ORAL 50MG

Facility

$7.00

Hospital Charge Code	60633164
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

AZATHIOPRINE ORAL 50MG

Facility

$7.00

Hospital Charge Code	60633164
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

AZELASTINE NSL SPR 137MCG

Facility

$348.85

Hospital Charge Code	60628751
Hospital Revenue Code	250
Min. Negotiated Rate	$52.33
Max. Negotiated Rate	$52.33
Rate for Payer: Qualcare PPO/HMO/WC	$52.33

AZELASTINE NSL SPR 137MCG

Facility

$348.85

Hospital Charge Code	60628751
Hospital Revenue Code	250
Min. Negotiated Rate	$45.35
Max. Negotiated Rate	$174.43
Rate for Payer: Aetna Commercial	$104.66
Rate for Payer: Aetna Medicare Advantage	$104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.96
Rate for Payer: Cigna Commercial	$174.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.35
Rate for Payer: Oxford Commercial	$174.43
Rate for Payer: Qualcare PPO/HMO/WC	$52.33
Rate for Payer: UnitedHealthcare Commercial	$174.43

AZILECT 0.5MG TABLET

Facility

$38.00

Hospital Charge Code	60635571
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

AZILECT 0.5MG TABLET

Facility

$38.00

Hospital Charge Code	60635571
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

AZITHROMYCIN 100 MG/5 ML SUSP

Facility

$42.34

Service Code	NDC 69311019
Hospital Charge Code	60629272
Hospital Revenue Code	250
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$21.17
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.80
Rate for Payer: Cigna Commercial	$21.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.50
Rate for Payer: Oxford Commercial	$21.17
Rate for Payer: Qualcare PPO/HMO/WC	$6.35
Rate for Payer: UnitedHealthcare Commercial	$21.17

AZITHROMYCIN 100 MG/5 ML SUSP

Facility

$42.34

Service Code	NDC 69311019
Hospital Charge Code	60629272
Hospital Revenue Code	250
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$6.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.35

AZITHROMYCIN 200 MG/5 ML SUSP

Facility

$28.21

Service Code	NDC 69313019
Hospital Charge Code	60627272
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$14.11
Rate for Payer: Aetna Commercial	$8.46
Rate for Payer: Aetna Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.19
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.67
Rate for Payer: Oxford Commercial	$14.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$14.11

AZITHROMYCIN 200 MG/5 ML SUSP

Facility

$28.21

Service Code	NDC 69313019
Hospital Charge Code	60627272
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

AZITHROMYCIN 250 MG TAB UD

Facility

$52.06

Service Code	NDC 69406189
Hospital Charge Code	60628569
Hospital Revenue Code	250
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$26.03
Rate for Payer: Aetna Commercial	$15.62
Rate for Payer: Aetna Medicare Advantage	$15.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.28
Rate for Payer: Cigna Commercial	$26.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.77
Rate for Payer: Oxford Commercial	$26.03
Rate for Payer: Qualcare PPO/HMO/WC	$7.81
Rate for Payer: UnitedHealthcare Commercial	$26.03

Know your out-of-pocket cost for care.

All Charges