Heights University Hospital

All Charges

Charge

Type

Setting

Price

POVIDONE IODINE 10 % OIN

Facility

$22.11

Service Code	NDC 904110231
Hospital Charge Code	6004550
Hospital Revenue Code	250
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.32

POVIDONE IODINE 10 % OIN

Facility

$22.11

Service Code	NDC 904110231
Hospital Charge Code	6004550
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$6.63
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.64
Rate for Payer: Cigna Commercial	$11.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.32
Rate for Payer: UnitedHealthcare Commercial	$11.05

POVIDONE IODINE 10% SOL 14 ML

Facility

$4.50

Hospital Charge Code	60628747
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

POVIDONE IODINE 10% SOL 14 ML

Facility

$4.50

Hospital Charge Code	60628747
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

POVIDONE IODINE 1 OINT OIN

Facility

$4.00

Service Code	NDC 52380002601
Hospital Charge Code	60628355
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

POVIDONE IODINE 1 OINT OIN

Facility

$4.00

Service Code	NDC 52380002601
Hospital Charge Code	60628355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POVIDONE IODINE 5% AEROSOL

Facility

$66.45

Hospital Charge Code	60628361
Hospital Revenue Code	250
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

POVIDONE IODINE 5% AEROSOL

Facility

$66.45

Hospital Charge Code	60628361
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$19.93
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.64
Rate for Payer: Oxford Commercial	$33.23
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$33.23

POVIDONE/IODINE 5% SPRAY

Facility

$4.00

Service Code	NDC 52380190500
Hospital Charge Code	60632235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POVIDONE/IODINE 5% SPRAY

Facility

$4.00

Service Code	NDC 52380190500
Hospital Charge Code	60632235
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

POVIDONE IODINE DCHE VG 14.8ML

Facility

$19.85

Hospital Charge Code	6004576
Hospital Revenue Code	252
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

POVIDONE IODINE DCHE VG 14.8ML

Facility

$19.85

Hospital Charge Code	6004576
Hospital Revenue Code	252
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

POVIDONE IODINE GEL 10%

Facility

$3.85

Hospital Charge Code	60628360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

POVIDONE IODINE GEL 10%

Facility

$3.85

Hospital Charge Code	60628360
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

POVIDONE IODINE GEL VAG 5GM

Facility

$52.50

Hospital Charge Code	6004568
Hospital Revenue Code	252
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

POVIDONE IODINE GEL VAG 5GM

Facility

$52.50

Hospital Charge Code	6004568
Hospital Revenue Code	252
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

POVIDONE-IODINE OP SOL 5% 30ML

Facility

$90.52

Service Code	NDC 65041130
Hospital Charge Code	60628976
Hospital Revenue Code	250
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$45.26
Rate for Payer: Aetna Commercial	$27.16
Rate for Payer: Aetna Medicare Advantage	$27.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.08
Rate for Payer: Cigna Commercial	$45.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.77
Rate for Payer: Oxford Commercial	$45.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.58
Rate for Payer: UnitedHealthcare Commercial	$45.26

POVIDONE-IODINE OP SOL 5% 30ML

Facility

$90.52

Service Code	NDC 65041130
Hospital Charge Code	60628976
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$13.58

POVIDONE IODINE SOL OPH5% 50MG

Facility

$73.00

Hospital Charge Code	6007454
Hospital Revenue Code	252
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

POVIDONE IODINE SOL OPH5% 50MG

Facility

$73.00

Hospital Charge Code	6007454
Hospital Revenue Code	252
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

POVIDONE-IODINE SWABSTICKS

Facility

$33.90

Service Code	NDC 52380003807
Hospital Charge Code	606390093
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$5.08

POVIDONE-IODINE SWABSTICKS

Facility

$33.90

Service Code	NDC 52380003807
Hospital Charge Code	606390093
Hospital Revenue Code	250
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$16.95
Rate for Payer: Aetna Commercial	$10.17
Rate for Payer: Aetna Medicare Advantage	$10.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.64
Rate for Payer: Cigna Commercial	$16.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.41
Rate for Payer: Oxford Commercial	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.08
Rate for Payer: UnitedHealthcare Commercial	$16.95

POVIDONE SOL 10% 120ML

Facility

$7.70

Hospital Charge Code	60628356
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

POVIDONE SOL 10% 120ML

Facility

$7.70

Hospital Charge Code	60628356
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

POVIDONE SOL 10% 946ML

Facility

$32.00

Hospital Charge Code	60628357
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

Know your out-of-pocket cost for care.

All Charges