Heights University Hospital

All Charges

Charge

Type

Setting

Price

ZOSTRIX/30GM

Facility

$110.55

Service Code	NDC 603064888
Hospital Charge Code	60634302
Hospital Revenue Code	250
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$55.27
Rate for Payer: Aetna Commercial	$33.16
Rate for Payer: Aetna Medicare Advantage	$33.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.19
Rate for Payer: Cigna Commercial	$55.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.37
Rate for Payer: Oxford Commercial	$55.27
Rate for Payer: Qualcare PPO/HMO/WC	$16.58
Rate for Payer: UnitedHealthcare Commercial	$55.27

ZOSYN 2.25GM ADD-VANT VIA

Facility

$25.00

Hospital Charge Code	60635368
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

ZOSYN 2.25GM ADD-VANT VIA

Facility

$25.00

Hospital Charge Code	60635368
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

ZOSYN 2.25GM VIAL

Facility

$61.05

Hospital Charge Code	60635764
Hospital Revenue Code	636
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$14.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.16

ZOSYN 2.25GM VIAL

Facility

$61.05

Hospital Charge Code	60635764
Hospital Revenue Code	636
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$30.52
Rate for Payer: Aetna Commercial	$18.32
Rate for Payer: Aetna Medicare Advantage	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.57
Rate for Payer: Cigna Commercial	$30.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.16

ZOSYN 3.375GM ADDV/D5W1

Facility

$72.00

Hospital Charge Code	60635169
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

ZOSYN 3.375GM ADDV/D5W1

Facility

$72.00

Hospital Charge Code	60635169
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

ZOSYN,4.5ML,ADVANTAGE,VIA

Facility

$32.00

Hospital Charge Code	60635427
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ZOSYN,4.5ML,ADVANTAGE,VIA

Facility

$32.00

Hospital Charge Code	60635427
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

ZOVIRAX/200MG/5ML

Facility

$479.00

Hospital Charge Code	60634208
Hospital Revenue Code	250
Min. Negotiated Rate	$62.27
Max. Negotiated Rate	$239.50
Rate for Payer: Aetna Commercial	$143.70
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.27
Rate for Payer: Oxford Commercial	$239.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$239.50

ZOVIRAX/200MG/5ML

Facility

$479.00

Hospital Charge Code	60634208
Hospital Revenue Code	250
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

ZOVIRAX/200MG/CAP

Facility

$6.00

Hospital Charge Code	60634206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

ZOVIRAX/200MG/CAP

Facility

$5.00

Hospital Charge Code	60634207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

ZOVIRAX/200MG/CAP

Facility

$6.00

Hospital Charge Code	60634206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

ZOVIRAX/200MG/CAP

Facility

$5.00

Hospital Charge Code	60634207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

ZOVIRAX 400MG U/D TAB

Facility

$12.66

Service Code	NDC 93894301
Hospital Charge Code	60635283
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$6.33
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.23
Rate for Payer: Cigna Commercial	$6.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.65
Rate for Payer: Oxford Commercial	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.90
Rate for Payer: UnitedHealthcare Commercial	$6.33

ZOVIRAX 400MG U/D TAB

Facility

$12.66

Service Code	NDC 93894301
Hospital Charge Code	60635283
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.90

ZOVIRAX/500MG

Facility

$266.00

Hospital Charge Code	60634205
Hospital Revenue Code	250
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

ZOVIRAX/500MG

Facility

$266.00

Hospital Charge Code	60634205
Hospital Revenue Code	250
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$133.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$133.00

ZOVIRAX 5%/15GM

Facility

$196.00

Hospital Charge Code	60634210
Hospital Revenue Code	250
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

ZOVIRAX 5%/15GM

Facility

$196.00

Hospital Charge Code	60634210
Hospital Revenue Code	250
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$98.00
Rate for Payer: Aetna Commercial	$58.80
Rate for Payer: Aetna Medicare Advantage	$58.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.98
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.48
Rate for Payer: Oxford Commercial	$98.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Commercial	$98.00

ZOVIRAX/800MG/TAB

Facility

$15.00

Hospital Charge Code	60634648
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

ZOVIRAX/800MG/TAB

Facility

$15.00

Hospital Charge Code	60634648
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

Z PLATE FLARED PC 6X34MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270698012
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.00
Max. Negotiated Rate	$10,040.00
Rate for Payer: Aetna Commercial	$6,024.00
Rate for Payer: Aetna Medicare Advantage	$6,024.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,120.40
Rate for Payer: Cigna Commercial	$10,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00

Z PLATE FLARED PC 6X34MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270698012
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.00
Max. Negotiated Rate	$4,859.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00

Know your out-of-pocket cost for care.

All Charges