Heights University Hospital

All Charges

Charge

Type

Setting

Price

BETAPACE/240MG/CAP

Facility

$47.24

Service Code	NDC 50419010710
Hospital Charge Code	60634906
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$14.17
Rate for Payer: Aetna Medicare Advantage	$14.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.14
Rate for Payer: Oxford Commercial	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$23.62

BETAPACE 240MG TAB

Facility

$26.00

Hospital Charge Code	60635109
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

BETAPACE 240MG TAB

Facility

$26.00

Hospital Charge Code	60635109
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

BETAPACE/80MG/CAP

Facility

$7.00

Hospital Charge Code	60634904
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

BETAPACE/80MG/CAP

Facility

$7.00

Hospital Charge Code	60634904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

BETASEPT SURG SCRUB 4% 120ML

Facility

$9.00

Hospital Charge Code	6016273
Hospital Revenue Code	251
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

BETASEPT SURG SCRUB 4% 120ML

Facility

$9.00

Hospital Charge Code	6016273
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

BETAXOLOL 0.25% OPHTH SUSP

Facility

$212.00

Hospital Charge Code	60628084
Hospital Revenue Code	250
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

BETAXOLOL 0.25% OPHTH SUSP

Facility

$212.00

Hospital Charge Code	60628084
Hospital Revenue Code	250
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$63.60
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$106.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$106.00

BETAXOLOL 0.5% OPHTH SOLN

Facility

$67.25

Hospital Charge Code	6000699
Hospital Revenue Code	252
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$33.62
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$33.62

BETAXOLOL 0.5% OPHTH SOLN

Facility

$67.25

Hospital Charge Code	6000699
Hospital Revenue Code	252
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

BETHANACOL 5MG TAB

Facility

$4.76

Service Code	NDC 115951101
Hospital Charge Code	6063943064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$1.43
Rate for Payer: Aetna Medicare Advantage	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.21
Rate for Payer: Cigna Commercial	$2.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.62
Rate for Payer: Oxford Commercial	$2.38
Rate for Payer: Qualcare PPO/HMO/WC	$0.71
Rate for Payer: UnitedHealthcare Commercial	$2.38

BETHANACOL 5MG TAB

Facility

$4.76

Service Code	NDC 115951101
Hospital Charge Code	6063943064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.71

BETHANECHOL 10 MG TAB

Facility

$13.40

Service Code	NDC 832051100
Hospital Charge Code	60627411
Hospital Revenue Code	251
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.42
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.01
Rate for Payer: UnitedHealthcare Commercial	$6.70

BETHANECHOL 10 MG TAB

Facility

$13.40

Service Code	NDC 832051100
Hospital Charge Code	60627411
Hospital Revenue Code	251
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.01

BETHANECHOL 25 MG TAB

Facility

$17.89

Service Code	NDC 832051201
Hospital Charge Code	60627412
Hospital Revenue Code	251
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

BETHANECHOL 25 MG TAB

Facility

$17.89

Service Code	NDC 832051201
Hospital Charge Code	60627412
Hospital Revenue Code	251
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$5.37
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$8.95

BETHANECHOL CHLORIDE/10MG

Facility

$3.00

Hospital Charge Code	60632557
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

BETHANECHOL CHLORIDE/10MG

Facility

$3.00

Hospital Charge Code	60632557
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BETHANECHOL CHLORIDE/25MG

Facility

$4.00

Hospital Charge Code	60632559
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BETHANECHOL CHLORIDE/25MG

Facility

$4.00

Hospital Charge Code	60632559
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

BETHANECHOL CHLORIDE/50MG

Facility

$3.00

Hospital Charge Code	60632558
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BETHANECHOL CHLORIDE/50MG

Facility

$3.00

Hospital Charge Code	60632558
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

BETHANECHOL CHLORIDE 50 MG TAB

Facility

$19.10

Service Code	NDC 115954401
Hospital Charge Code	6063943187
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.87

BETHANECHOL CHLORIDE 50 MG TAB

Facility

$19.10

Service Code	NDC 115954401
Hospital Charge Code	6063943187
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$5.73
Rate for Payer: Aetna Medicare Advantage	$5.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.87
Rate for Payer: Cigna Commercial	$9.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.48
Rate for Payer: Oxford Commercial	$9.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.87
Rate for Payer: UnitedHealthcare Commercial	$9.55

Know your out-of-pocket cost for care.

All Charges