Heights University Hospital

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 250 MG TAB UD

Facility

$52.06

Service Code	NDC 69406189
Hospital Charge Code	60628569
Hospital Revenue Code	250
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$7.81
Rate for Payer: Qualcare PPO/HMO/WC	$7.81

AZITHROMYCIN 500 MG INJ

Facility

$132.00

Hospital Charge Code	60635548
Hospital Revenue Code	636
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.94
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

AZITHROMYCIN 500 MG INJ

Facility

$132.00

Hospital Charge Code	60635548
Hospital Revenue Code	636
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$31.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.94
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

AZITHROMYCIN 500MG/NS 250ML

Facility

$104.19

Service Code	HCPCS J0456
Hospital Charge Code	60628965
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$31.26
Rate for Payer: Aetna Commercial	$31.26
Rate for Payer: Aetna Medicare Advantage	$31.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.57
Rate for Payer: Cigna Commercial	$1.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.63

AZITHROMYCIN 500MG/NS 250ML

Facility

$104.19

Service Code	HCPCS J0456
Hospital Charge Code	60628965
Hospital Revenue Code	636
Min. Negotiated Rate	$15.63
Max. Negotiated Rate	$25.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.63

AZITHROMYCIN 600MG TABLET

Facility

$359.66

Service Code	NDC 69308030
Hospital Charge Code	60632286
Hospital Revenue Code	250
Min. Negotiated Rate	$53.95
Max. Negotiated Rate	$53.95
Rate for Payer: Qualcare PPO/HMO/WC	$53.95

AZITHROMYCIN 600MG TABLET

Facility

$359.66

Service Code	NDC 69308030
Hospital Charge Code	60632286
Hospital Revenue Code	250
Min. Negotiated Rate	$46.76
Max. Negotiated Rate	$179.83
Rate for Payer: Aetna Commercial	$107.90
Rate for Payer: Aetna Medicare Advantage	$107.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.71
Rate for Payer: Cigna Commercial	$179.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.76
Rate for Payer: Oxford Commercial	$179.83
Rate for Payer: Qualcare PPO/HMO/WC	$53.95
Rate for Payer: UnitedHealthcare Commercial	$179.83

AZITHROMYCIN CAP 250MG

Facility

$46.10

Hospital Charge Code	6010649
Hospital Revenue Code	252
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$23.05
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.76
Rate for Payer: Cigna Commercial	$23.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Oxford Commercial	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.92
Rate for Payer: UnitedHealthcare Commercial	$23.05

AZITHROMYCIN CAP 250MG

Facility

$46.10

Hospital Charge Code	6010649
Hospital Revenue Code	252
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

AZMACORT/20GM

Facility

$207.00

Hospital Charge Code	60632520
Hospital Revenue Code	250
Min. Negotiated Rate	$26.91
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Aetna Medicare Advantage	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$103.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.91
Rate for Payer: Oxford Commercial	$103.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$103.50

AZMACORT/20GM

Facility

$207.00

Hospital Charge Code	60632520
Hospital Revenue Code	250
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.05

AZO-GANTANOL/TAB

Facility

$6.00

Hospital Charge Code	60632521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

AZO-GANTANOL/TAB

Facility

$6.00

Hospital Charge Code	60632521
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

AZO-GANTRISIN/TAB

Facility

$3.00

Hospital Charge Code	60632522
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

AZO-GANTRISIN/TAB

Facility

$3.00

Hospital Charge Code	60632522
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AZTREONAM

Facility

$535.00

Service Code	NDC 63323040120
Hospital Charge Code	60627267
Hospital Revenue Code	250
Min. Negotiated Rate	$69.55
Max. Negotiated Rate	$267.50
Rate for Payer: Aetna Commercial	$160.50
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.43
Rate for Payer: Cigna Commercial	$267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.55
Rate for Payer: Oxford Commercial	$267.50
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$267.50

AZTREONAM

Facility

$535.00

Service Code	NDC 63323040120
Hospital Charge Code	60627267
Hospital Revenue Code	250
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

AZTREONAM 2 GM INJ

Facility

$545.31

Service Code	NDC 3257016
Hospital Charge Code	60627269
Hospital Revenue Code	250
Min. Negotiated Rate	$70.89
Max. Negotiated Rate	$272.65
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$163.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.05
Rate for Payer: Cigna Commercial	$272.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.89
Rate for Payer: Oxford Commercial	$272.65
Rate for Payer: Qualcare PPO/HMO/WC	$81.80
Rate for Payer: UnitedHealthcare Commercial	$272.65

AZTREONAM 2 GM INJ

Facility

$545.31

Service Code	NDC 3257016
Hospital Charge Code	60627269
Hospital Revenue Code	250
Min. Negotiated Rate	$81.80
Max. Negotiated Rate	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.80

AZTREONAM 500 MG INJ

Facility

$102.04

Service Code	NDC 3256016
Hospital Charge Code	60627271
Hospital Revenue Code	250
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

AZTREONAM 500 MG INJ

Facility

$102.04

Service Code	NDC 3256016
Hospital Charge Code	60627271
Hospital Revenue Code	250
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$30.61
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.27
Rate for Payer: Oxford Commercial	$51.02
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$51.02

AZTREONAM INJ 1GM/15ML

Facility

$122.25

Hospital Charge Code	6007157
Hospital Revenue Code	250
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

AZTREONAM INJ 1GM/15ML

Facility

$122.25

Hospital Charge Code	6007157
Hospital Revenue Code	250
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$36.67
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Oxford Commercial	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$61.12

AZTREONAM IVPB 1GM/NS 100ML

Facility

$37.80

Hospital Charge Code	60627266
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

AZTREONAM IVPB 1GM/NS 100ML

Facility

$37.80

Hospital Charge Code	60627266
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

Know your out-of-pocket cost for care.

All Charges