Heights University Hospital

All Charges

Charge

Type

Setting

Price

BHI AGAR W/VANCO

Facility

$50.00

Hospital Charge Code	270666700
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

BIAFINE (WIDE) 1.5 OZ

Facility

$49.00

Hospital Charge Code	60635260
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

BIAFINE (WIDE) 1.5 OZ

Facility

$49.00

Hospital Charge Code	60635260
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

BIAXIN 250MG TABS

Facility

$9.00

Hospital Charge Code	60634748
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

BIAXIN 250MG TABS

Facility

$9.00

Hospital Charge Code	60634748
Hospital Revenue Code	250
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

BIAXIN/500MG/TAB

Facility

$15.00

Hospital Charge Code	60634256
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

BIAXIN/500MG/TAB

Facility

$15.00

Hospital Charge Code	60634256
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

BIAXIN LIQUID/250MG/5ML

Facility

$169.00

Hospital Charge Code	60634987
Hospital Revenue Code	250
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

BIAXIN LIQUID/250MG/5ML

Facility

$169.00

Hospital Charge Code	60634987
Hospital Revenue Code	250
Min. Negotiated Rate	$21.97
Max. Negotiated Rate	$84.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$50.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.09
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.97
Rate for Payer: Oxford Commercial	$84.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$84.50

BIAXIN SUPP/125MG/5

Facility

$141.00

Hospital Charge Code	60634975
Hospital Revenue Code	250
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

BIAXIN SUPP/125MG/5

Facility

$141.00

Hospital Charge Code	60634975
Hospital Revenue Code	250
Min. Negotiated Rate	$18.33
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.95
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.33
Rate for Payer: Oxford Commercial	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$70.50

BICALUTAMIDE 50 MG TAB

Facility

$124.35

Service Code	NDC 93022056
Hospital Charge Code	60627365
Hospital Revenue Code	250
Min. Negotiated Rate	$18.65
Max. Negotiated Rate	$18.65
Rate for Payer: Qualcare PPO/HMO/WC	$18.65

BICALUTAMIDE 50 MG TAB

Facility

$124.35

Service Code	NDC 93022056
Hospital Charge Code	60627365
Hospital Revenue Code	250
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$62.17
Rate for Payer: Aetna Commercial	$37.30
Rate for Payer: Aetna Medicare Advantage	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.71
Rate for Payer: Cigna Commercial	$62.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.17
Rate for Payer: Oxford Commercial	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$18.65
Rate for Payer: UnitedHealthcare Commercial	$62.17

BICARB KIT #2 635641000

Facility

$47.25

Hospital Charge Code	270606198
Hospital Revenue Code	270
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

BICARB KIT #2 635641000

Facility

$47.25

Hospital Charge Code	270606198
Hospital Revenue Code	270
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$14.18
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

BICARBONATE BAXTER PO

Facility

$77.65

Hospital Charge Code	270604633
Hospital Revenue Code	270
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$38.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$38.83

BICARBONATE BAXTER PO

Facility

$77.65

Hospital Charge Code	270604633
Hospital Revenue Code	270
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

BICARBONATE (CARBON DIOXIDE)

Facility

$52.85

Service Code	HCPCS 82374
Hospital Charge Code	8200305RS
Hospital Revenue Code	301
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

BICARBONATE (CARBON DIOXIDE)

Facility

$52.85

Service Code	HCPCS 82374
Hospital Charge Code	8200305RS
Hospital Revenue Code	301
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.88
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: Cigna Medicare Advantage	$2.44
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.17
Rate for Payer: Wellcare Medicare Advantage	$4.88

BICARBONATE LIQ

Facility

$43.25

Hospital Charge Code	8200313
Hospital Revenue Code	279
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$21.62
Rate for Payer: Aetna Commercial	$12.97
Rate for Payer: Aetna Medicare Advantage	$12.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.03
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$21.62
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$21.62

BICARBONATE LIQ

Facility

$43.25

Hospital Charge Code	8200313
Hospital Revenue Code	279
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

BICARBONATE LIQ BC-1-L

Facility

$29.65

Hospital Charge Code	270605142
Hospital Revenue Code	270
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

BICARBONATE LIQ BC-1-L

Facility

$29.65

Hospital Charge Code	270605142
Hospital Revenue Code	270
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

BICARBONATE SODIUM

Facility

$69.65

Hospital Charge Code	270604384
Hospital Revenue Code	270
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$34.83
Rate for Payer: Aetna Commercial	$20.89
Rate for Payer: Aetna Medicare Advantage	$20.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.76
Rate for Payer: Cigna Commercial	$34.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.05
Rate for Payer: Oxford Commercial	$34.83
Rate for Payer: Qualcare PPO/HMO/WC	$10.45
Rate for Payer: UnitedHealthcare Commercial	$34.83

BICARBONATE SODIUM

Facility

$69.65

Hospital Charge Code	270604384
Hospital Revenue Code	270
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$10.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.45

Know your out-of-pocket cost for care.

All Charges