Heights University Hospital

All Charges

Charge

Type

Setting

Price

STAVUDINE 15 MG CAP

Facility

$33.80

Hospital Charge Code	60628708
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.07

STAVUDINE 20 MG CAP

Facility

$35.15

Hospital Charge Code	60628709
Hospital Revenue Code	250
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$17.57
Rate for Payer: Aetna Commercial	$10.54
Rate for Payer: Aetna Medicare Advantage	$10.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.96
Rate for Payer: Cigna Commercial	$17.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.57
Rate for Payer: Oxford Commercial	$17.57
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$17.57

STAVUDINE 20 MG CAP

Facility

$35.15

Hospital Charge Code	60628709
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

STAVUDINE 20MG CAPSULE

Facility

$57.08

Service Code	NDC 3196501
Hospital Charge Code	60632297
Hospital Revenue Code	250
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$8.56
Rate for Payer: Qualcare PPO/HMO/WC	$8.56

STAVUDINE 20MG CAPSULE

Facility

$57.08

Service Code	NDC 3196501
Hospital Charge Code	60632297
Hospital Revenue Code	250
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$28.54
Rate for Payer: Aetna Commercial	$17.12
Rate for Payer: Aetna Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.56
Rate for Payer: Cigna Commercial	$28.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.42
Rate for Payer: Oxford Commercial	$28.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.56
Rate for Payer: UnitedHealthcare Commercial	$28.54

STAVUDINE 30 MG CAP

Facility

$37.30

Hospital Charge Code	60628710
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$5.59

STAVUDINE 30 MG CAP

Facility

$37.30

Hospital Charge Code	60628710
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$18.65
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: Aetna Medicare Advantage	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.51
Rate for Payer: Cigna Commercial	$18.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.85
Rate for Payer: Oxford Commercial	$18.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.59
Rate for Payer: UnitedHealthcare Commercial	$18.65

STAVUDINE 30MG CAPSULE

Facility

$60.64

Service Code	NDC 3196601
Hospital Charge Code	60632296
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$30.32
Rate for Payer: Aetna Commercial	$18.19
Rate for Payer: Aetna Medicare Advantage	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.46
Rate for Payer: Cigna Commercial	$30.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.88
Rate for Payer: Oxford Commercial	$30.32
Rate for Payer: Qualcare PPO/HMO/WC	$9.10
Rate for Payer: UnitedHealthcare Commercial	$30.32

STAVUDINE 30MG CAPSULE

Facility

$60.64

Service Code	NDC 3196601
Hospital Charge Code	60632296
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$9.10
Rate for Payer: Qualcare PPO/HMO/WC	$9.10

STAVUDINE 40 MG CAP

Facility

$38.00

Hospital Charge Code	60628711
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

STAVUDINE 40 MG CAP

Facility

$38.00

Hospital Charge Code	60628711
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

STAVUDINE 40MG CAPSULE

Facility

$61.77

Service Code	NDC 3196701
Hospital Charge Code	60632295
Hospital Revenue Code	250
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$30.89
Rate for Payer: Aetna Commercial	$18.53
Rate for Payer: Aetna Medicare Advantage	$18.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.75
Rate for Payer: Cigna Commercial	$30.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.03
Rate for Payer: Oxford Commercial	$30.89
Rate for Payer: Qualcare PPO/HMO/WC	$9.27
Rate for Payer: UnitedHealthcare Commercial	$30.89

STAVUDINE 40MG CAPSULE

Facility

$61.77

Service Code	NDC 3196701
Hospital Charge Code	60632295
Hospital Revenue Code	250
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$9.27

STAYFUSE 3.8 GREY 2227-002-02

Facility

$644.85

Hospital Charge Code	270630416
Hospital Revenue Code	272
Min. Negotiated Rate	$96.73
Max. Negotiated Rate	$96.73
Rate for Payer: Qualcare PPO/HMO/WC	$96.73

STAYFUSE 3.8 GREY 2227-002-02

Facility

$644.85

Hospital Charge Code	270630416
Hospital Revenue Code	272
Min. Negotiated Rate	$83.83
Max. Negotiated Rate	$322.43
Rate for Payer: Aetna Commercial	$193.46
Rate for Payer: Aetna Medicare Advantage	$193.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.44
Rate for Payer: Cigna Commercial	$322.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.83
Rate for Payer: Oxford Commercial	$322.43
Rate for Payer: Qualcare PPO/HMO/WC	$96.73
Rate for Payer: UnitedHealthcare Commercial	$322.43

STAYFUSE 4 3mx6m GRY 222700402

Facility

$694.45

Hospital Charge Code	270630415
Hospital Revenue Code	272
Min. Negotiated Rate	$90.28
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$208.34
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.28
Rate for Payer: Oxford Commercial	$347.23
Rate for Payer: Qualcare PPO/HMO/WC	$104.17
Rate for Payer: UnitedHealthcare Commercial	$347.23

STAYFUSE 4 3mx6m GRY 222700402

Facility

$694.45

Hospital Charge Code	270630415
Hospital Revenue Code	272
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$104.17
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STAYFUSE MID 4.3 X 6 2270302

Facility

$680.85

Hospital Charge Code	270625958
Hospital Revenue Code	272
Min. Negotiated Rate	$88.51
Max. Negotiated Rate	$340.43
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare Advantage	$204.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.62
Rate for Payer: Cigna Commercial	$340.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.51
Rate for Payer: Oxford Commercial	$340.43
Rate for Payer: Qualcare PPO/HMO/WC	$102.13
Rate for Payer: UnitedHealthcare Commercial	$340.43

STAYFUSE MID 4.3 X 6 2270302

Facility

$680.85

Hospital Charge Code	270625958
Hospital Revenue Code	272
Min. Negotiated Rate	$102.13
Max. Negotiated Rate	$102.13
Rate for Payer: Qualcare PPO/HMO/WC	$102.13

STAYFUSE MID 5.0x6GR 222700404

Facility

$694.45

Hospital Charge Code	270633521
Hospital Revenue Code	272
Min. Negotiated Rate	$90.28
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$208.34
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.28
Rate for Payer: Oxford Commercial	$347.23
Rate for Payer: Qualcare PPO/HMO/WC	$104.17
Rate for Payer: UnitedHealthcare Commercial	$347.23

STAYFUSE MID 5.0x6GR 222700404

Facility

$694.45

Hospital Charge Code	270633521
Hospital Revenue Code	272
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$104.17
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STAYFUSE PROX 2.8mm 2270101

Facility

$680.85

Hospital Charge Code	270625956
Hospital Revenue Code	272
Min. Negotiated Rate	$88.51
Max. Negotiated Rate	$340.43
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare Advantage	$204.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.62
Rate for Payer: Cigna Commercial	$340.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.51
Rate for Payer: Oxford Commercial	$340.43
Rate for Payer: Qualcare PPO/HMO/WC	$102.13
Rate for Payer: UnitedHealthcare Commercial	$340.43

STAYFUSE PROX 2.8mm 2270101

Facility

$680.85

Hospital Charge Code	270625956
Hospital Revenue Code	272
Min. Negotiated Rate	$102.13
Max. Negotiated Rate	$102.13
Rate for Payer: Qualcare PPO/HMO/WC	$102.13

STAYFUSE PROX 3.3M GR 22270201

Facility

$644.85

Hospital Charge Code	270626860
Hospital Revenue Code	272
Min. Negotiated Rate	$96.73
Max. Negotiated Rate	$96.73
Rate for Payer: Qualcare PPO/HMO/WC	$96.73

STAYFUSE PROX 3.3M GR 22270201

Facility

$644.85

Hospital Charge Code	270626860
Hospital Revenue Code	272
Min. Negotiated Rate	$83.83
Max. Negotiated Rate	$322.43
Rate for Payer: Aetna Commercial	$193.46
Rate for Payer: Aetna Medicare Advantage	$193.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.44
Rate for Payer: Cigna Commercial	$322.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.83
Rate for Payer: Oxford Commercial	$322.43
Rate for Payer: Qualcare PPO/HMO/WC	$96.73
Rate for Payer: UnitedHealthcare Commercial	$322.43

Know your out-of-pocket cost for care.

All Charges