Heights University Hospital

All Charges

Charge

Type

Setting

Price

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038130
Hospital Revenue Code	300
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

BETAMETHASONE CLOTRI CRM 15OZ

Facility

$109.45

Hospital Charge Code	6000681
Hospital Revenue Code	251
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$54.73

BETAMETHASONE CLOTRI CRM 15OZ

Facility

$109.45

Hospital Charge Code	6000681
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

BETAMETHASONE/CLOTRIMAZOLE

Facility

$995.35

Service Code	NDC 168025815
Hospital Charge Code	60628337
Hospital Revenue Code	250
Min. Negotiated Rate	$149.30
Max. Negotiated Rate	$149.30
Rate for Payer: Qualcare PPO/HMO/WC	$149.30

BETAMETHASONE/CLOTRIMAZOLE

Facility

$995.35

Service Code	NDC 168025815
Hospital Charge Code	60628337
Hospital Revenue Code	250
Min. Negotiated Rate	$129.40
Max. Negotiated Rate	$497.68
Rate for Payer: Aetna Commercial	$298.61
Rate for Payer: Aetna Medicare Advantage	$298.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.81
Rate for Payer: Cigna Commercial	$497.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.40
Rate for Payer: Oxford Commercial	$497.68
Rate for Payer: Qualcare PPO/HMO/WC	$149.30
Rate for Payer: UnitedHealthcare Commercial	$497.68

BETAMETHASONE CRM 0.05%

Facility

$86.40

Hospital Charge Code	60628369
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

BETAMETHASONE CRM 0.05%

Facility

$86.40

Hospital Charge Code	60628369
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$43.20

BETAMETHASONE CRM 0.05% AF 15G

Facility

$254.27

Service Code	NDC 51672131001
Hospital Charge Code	606285574
Hospital Revenue Code	250
Min. Negotiated Rate	$38.14
Max. Negotiated Rate	$38.14
Rate for Payer: Qualcare PPO/HMO/WC	$38.14

BETAMETHASONE CRM 0.05% AF 15G

Facility

$254.27

Service Code	NDC 51672131001
Hospital Charge Code	606285574
Hospital Revenue Code	250
Min. Negotiated Rate	$33.06
Max. Negotiated Rate	$127.14
Rate for Payer: Aetna Commercial	$76.28
Rate for Payer: Aetna Medicare Advantage	$76.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.84
Rate for Payer: Cigna Commercial	$127.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.06
Rate for Payer: Oxford Commercial	$127.14
Rate for Payer: Qualcare PPO/HMO/WC	$38.14
Rate for Payer: UnitedHealthcare Commercial	$127.14

BETAMETHASONE CRM 15GM DIP

Facility

$122.90

Hospital Charge Code	6000665
Hospital Revenue Code	251
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

BETAMETHASONE CRM 15GM DIP

Facility

$122.90

Hospital Charge Code	6000665
Hospital Revenue Code	251
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$36.87
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.98
Rate for Payer: Oxford Commercial	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$61.45

BETAMETHASONE CRM 15GM VAL

Facility

$34.60

Hospital Charge Code	6000632
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

BETAMETHASONE CRM 15GM VAL

Facility

$34.60

Hospital Charge Code	6000632
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

BETAMETHASONE CRM VAL 1% 45GM

Facility

$53.80

Hospital Charge Code	6007199
Hospital Revenue Code	251
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

BETAMETHASONE CRM VAL 1% 45GM

Facility

$53.80

Hospital Charge Code	6007199
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

BETAMETHASONE DIP 0.05% OINT

Facility

$187.40

Service Code	NDC 168004015
Hospital Charge Code	6063943315
Hospital Revenue Code	250
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$93.70
Rate for Payer: Aetna Commercial	$56.22
Rate for Payer: Aetna Medicare Advantage	$56.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$93.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.36
Rate for Payer: Oxford Commercial	$93.70
Rate for Payer: Qualcare PPO/HMO/WC	$28.11
Rate for Payer: UnitedHealthcare Commercial	$93.70

BETAMETHASONE DIP 0.05% OINT

Facility

$187.40

Service Code	NDC 168004015
Hospital Charge Code	6063943315
Hospital Revenue Code	250
Min. Negotiated Rate	$28.11
Max. Negotiated Rate	$28.11
Rate for Payer: Qualcare PPO/HMO/WC	$28.11

BETAMETHASONE DIP 0.05%ONT 15G

Facility

$228.79

Hospital Charge Code	6063943372
Hospital Revenue Code	251
Min. Negotiated Rate	$29.74
Max. Negotiated Rate	$114.39
Rate for Payer: Aetna Commercial	$68.64
Rate for Payer: Aetna Medicare Advantage	$68.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.34
Rate for Payer: Cigna Commercial	$114.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.74
Rate for Payer: Oxford Commercial	$114.39
Rate for Payer: Qualcare PPO/HMO/WC	$34.32
Rate for Payer: UnitedHealthcare Commercial	$114.39

BETAMETHASONE DIP 0.05%ONT 15G

Facility

$228.79

Hospital Charge Code	6063943372
Hospital Revenue Code	251
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$34.32
Rate for Payer: Qualcare PPO/HMO/WC	$34.32

BETAMETHASONE DIP 0.5% OINT

Facility

$31.02

Service Code	NDC 45802037635
Hospital Charge Code	606361047
Hospital Revenue Code	250
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$15.51
Rate for Payer: Aetna Commercial	$9.31
Rate for Payer: Aetna Medicare Advantage	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$15.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$15.51

BETAMETHASONE DIP 0.5% OINT

Facility

$31.02

Service Code	NDC 45802037635
Hospital Charge Code	606361047
Hospital Revenue Code	250
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

BETAMETHASONE DIPRO 0.05

Facility

$26.00

Hospital Charge Code	60632551
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

BETAMETHASONE DIPRO 0.05

Facility

$26.00

Hospital Charge Code	60632551
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

BETAMETHASONE DIPROP 0.05

Facility

$26.00

Hospital Charge Code	60632550
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

BETAMETHASONE DIPROP 0.05

Facility

$26.00

Hospital Charge Code	60632550
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

Know your out-of-pocket cost for care.

All Charges