Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHLORAPREP 1 STEP

Facility

$372.10

Hospital Charge Code	270652026
Hospital Revenue Code	272
Min. Negotiated Rate	$48.37
Max. Negotiated Rate	$186.05
Rate for Payer: Aetna Commercial	$111.63
Rate for Payer: Aetna Medicare Advantage	$111.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.89
Rate for Payer: Cigna Commercial	$186.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.37
Rate for Payer: Oxford Commercial	$186.05
Rate for Payer: Qualcare PPO/HMO/WC	$55.81
Rate for Payer: UnitedHealthcare Commercial	$186.05

CHLORAPREP ORNG 26 APPL 260815

Facility

$31.99

Hospital Charge Code	270301990C
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CHLORAPREP ORNG 26 APPL 260815

Facility

$31.99

Hospital Charge Code	270301990C
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$15.99
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	$15.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$15.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$15.99

CHLORAPREP ORNG TINT APPL 26ml

Facility

$778.75

Hospital Charge Code	270301990
Hospital Revenue Code	270
Min. Negotiated Rate	$101.24
Max. Negotiated Rate	$389.38
Rate for Payer: Aetna Commercial	$233.62
Rate for Payer: Aetna Medicare Advantage	$233.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.58
Rate for Payer: Cigna Commercial	$389.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.24
Rate for Payer: Oxford Commercial	$389.38
Rate for Payer: Qualcare PPO/HMO/WC	$116.81
Rate for Payer: UnitedHealthcare Commercial	$389.38

CHLORAPREP ORNG TINT APPL 26ml

Facility

$778.75

Hospital Charge Code	270301990
Hospital Revenue Code	270
Min. Negotiated Rate	$116.81
Max. Negotiated Rate	$116.81
Rate for Payer: Qualcare PPO/HMO/WC	$116.81

CHLORASCRUB SWAB 1.6ml S40750

Facility

$3.65

Hospital Charge Code	270640546
Hospital Revenue Code	272
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.82
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.93
Rate for Payer: Cigna Commercial	$1.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.47
Rate for Payer: Oxford Commercial	$1.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.55
Rate for Payer: UnitedHealthcare Commercial	$1.82

CHLORASCRUB SWAB 1.6ml S40750

Facility

$3.65

Hospital Charge Code	270640546
Hospital Revenue Code	272
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Qualcare PPO/HMO/WC	$0.55

CHLORASEPTIC LOZENGE

Facility

$4.00

Service Code	NDC 78112001106
Hospital Charge Code	606390542
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CHLORASEPTIC LOZENGE

Facility

$4.00

Service Code	NDC 78112001106
Hospital Charge Code	606390542
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

CHLORASEPTIC THROAT SPRAY

Facility

$7.00

Hospital Charge Code	60634601
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

CHLORASEPTIC THROAT SPRAY

Facility

$7.00

Hospital Charge Code	60634601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CHLORDIAZEPOXIDE

Facility

$1.95

Hospital Charge Code	6020051
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CHLORDIAZEPOXIDE

Facility

$1.95

Hospital Charge Code	6020051
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

CHLORDIAZEPOXIDE

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3031473
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CHLORDIAZEPOXIDE

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3031473
Hospital Revenue Code	301
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

CHLORDIAZEPOXIDE 10MG

Facility

$1.95

Hospital Charge Code	6020069
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

CHLORDIAZEPOXIDE 10MG

Facility

$1.95

Hospital Charge Code	6020069
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CHLORDIAZEPOXIDE 10 MG CAP

Facility

$4.15

Service Code	NDC 51079037520
Hospital Charge Code	60628590
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.54
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$2.08

CHLORDIAZEPOXIDE 10 MG CAP

Facility

$4.15

Service Code	NDC 51079037520
Hospital Charge Code	60628590
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

CHLORDIAZEPOXIDE/10MG/EA

Facility

$3.00

Hospital Charge Code	60632683
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORDIAZEPOXIDE/10MG/EA

Facility

$3.00

Hospital Charge Code	60632680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORDIAZEPOXIDE/10MG/EA

Facility

$3.00

Hospital Charge Code	60632680
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

CHLORDIAZEPOXIDE/10MG/EA

Facility

$3.00

Hospital Charge Code	60632683
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

CHLORDIAZEPOXIDE 25MG

Facility

$1.95

Hospital Charge Code	6020077
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

CHLORDIAZEPOXIDE 25MG

Facility

$1.95

Hospital Charge Code	6020077
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

Know your out-of-pocket cost for care.

All Charges