Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHLORAL HYDRATE 500MG/5ML

Facility

$5.65

Hospital Charge Code	6021182
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

CHLORAL HYDRATE 500MG/5ML

Facility

$5.65

Hospital Charge Code	6021182
Hospital Revenue Code	251
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

CHLORAL HYDRATE/500MG/5ML

Facility

$28.00

Hospital Charge Code	60634414
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

CHLORAL HYDRATE/500MG/5ML

Facility

$28.00

Hospital Charge Code	60634414
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

CHLORAL HYDRATE 5ML

Facility

$8.24

Service Code	NDC 51552052806
Hospital Charge Code	60635072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.07
Rate for Payer: Oxford Commercial	$4.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$4.12

CHLORAL HYDRATE 5ML

Facility

$8.24

Service Code	NDC 51552052806
Hospital Charge Code	60635072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

CHLORAMBUCIL 2 MG TAB

Facility

$85.83

Service Code	NDC 76388063550
Hospital Charge Code	60627368
Hospital Revenue Code	250
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$42.91
Rate for Payer: Aetna Commercial	$25.75
Rate for Payer: Aetna Medicare Advantage	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.89
Rate for Payer: Cigna Commercial	$42.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.16
Rate for Payer: Oxford Commercial	$42.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.87
Rate for Payer: UnitedHealthcare Commercial	$42.91

CHLORAMBUCIL 2 MG TAB

Facility

$85.83

Service Code	NDC 76388063550
Hospital Charge Code	60627368
Hospital Revenue Code	250
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$12.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.87

CHLORAMBUCIL TAB 2MG

Facility

$15.40

Hospital Charge Code	6009583
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

CHLORAMBUCIL TAB 2MG

Facility

$15.40

Hospital Charge Code	6009583
Hospital Revenue Code	251
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

CHLORAMPHENICOL 1.67MG/1ML OPS

Facility

$128.00

Hospital Charge Code	60629177
Hospital Revenue Code	250
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$64.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$64.00

CHLORAMPHENICOL 1.67MG/1ML OPS

Facility

$128.00

Hospital Charge Code	60629177
Hospital Revenue Code	250
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CHLORAMPHENICOL 1 % OPHT. OIN

Facility

$141.65

Hospital Charge Code	60628010
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

CHLORAMPHENICOL 1 % OPHT. OIN

Facility

$141.65

Hospital Charge Code	60628010
Hospital Revenue Code	250
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$70.83
Rate for Payer: Aetna Commercial	$42.49
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.41
Rate for Payer: Oxford Commercial	$70.83
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$70.83

CHLORAMPHENICOL INJ 1G

Facility

$33.65

Hospital Charge Code	60629178
Hospital Revenue Code	636
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$10.10
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

CHLORAMPHENICOL INJ 1G

Facility

$33.65

Hospital Charge Code	60629178
Hospital Revenue Code	636
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$8.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

CHLORAMPHENIC OPHT 0.5% SOLN

Facility

$4.85

Hospital Charge Code	6001085
Hospital Revenue Code	252
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

CHLORAMPHENIC OPHT 0.5% SOLN

Facility

$4.85

Hospital Charge Code	6001085
Hospital Revenue Code	252
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

CHLORAPREP 10.5 ML APPLICATOR

Facility

$18.17

Hospital Charge Code	270643289N
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$9.09
Rate for Payer: Aetna Commercial	$5.45
Rate for Payer: Aetna Medicare Advantage	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.63
Rate for Payer: Cigna Commercial	$9.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.36
Rate for Payer: Oxford Commercial	$9.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.73
Rate for Payer: UnitedHealthcare Commercial	$9.09

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289S
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.63

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289
Hospital Revenue Code	270
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$8.77
Rate for Payer: Aetna Commercial	$5.26
Rate for Payer: Aetna Medicare Advantage	$5.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.47
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.28
Rate for Payer: Oxford Commercial	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.63
Rate for Payer: UnitedHealthcare Commercial	$8.77

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289S
Hospital Revenue Code	270
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$8.77
Rate for Payer: Aetna Commercial	$5.26
Rate for Payer: Aetna Medicare Advantage	$5.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.47
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.28
Rate for Payer: Oxford Commercial	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.63
Rate for Payer: UnitedHealthcare Commercial	$8.77

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.63

CHLORAPREP 10.5 ML APPLICATOR

Facility

$18.17

Hospital Charge Code	270643289N
Hospital Revenue Code	270
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.73

CHLORAPREP 1 STEP

Facility

$372.10

Hospital Charge Code	270652026
Hospital Revenue Code	272
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$55.81
Rate for Payer: Qualcare PPO/HMO/WC	$55.81

Know your out-of-pocket cost for care.

All Charges