Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHLOROQUINE PHOSPHATE 500 MG TAB

Facility

$36.18

Service Code	NDC 63304046126
Hospital Charge Code	6063943189
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$18.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Commercial	$18.09

CHLOROQUINE PHOS TAB 250MG

Facility

$34.60

Hospital Charge Code	6009328
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

CHLOROQUINE PHOS TAB 250MG

Facility

$34.60

Hospital Charge Code	6009328
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

CHLOROTHIAZIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60627961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

CHLOROTHIAZIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60627961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CHLOROXINE 2% SHA

Facility

$178.45

Hospital Charge Code	60628330
Hospital Revenue Code	250
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$26.77
Rate for Payer: Qualcare PPO/HMO/WC	$26.77

CHLOROXINE 2% SHA

Facility

$178.45

Hospital Charge Code	60628330
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$89.22
Rate for Payer: Aetna Commercial	$53.53
Rate for Payer: Aetna Medicare Advantage	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.50
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.20
Rate for Payer: Oxford Commercial	$89.22
Rate for Payer: Qualcare PPO/HMO/WC	$26.77
Rate for Payer: UnitedHealthcare Commercial	$89.22

CHLORPACIN WCS-90 2 GM

Facility

$25.25

Hospital Charge Code	60628353W
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$12.62
Rate for Payer: Aetna Commercial	$7.58
Rate for Payer: Aetna Medicare Advantage	$7.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.44
Rate for Payer: Cigna Commercial	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.28
Rate for Payer: Oxford Commercial	$12.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Commercial	$12.62

CHLORPACIN WCS-90 2 GM

Facility

$25.25

Hospital Charge Code	60628353W
Hospital Revenue Code	250
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

CHLORPACTIN POWDER 2GM

Facility

$290.60

Hospital Charge Code	6006779
Hospital Revenue Code	252
Min. Negotiated Rate	$43.59
Max. Negotiated Rate	$43.59
Rate for Payer: Qualcare PPO/HMO/WC	$43.59

CHLORPACTIN POWDER 2GM

Facility

$290.60

Hospital Charge Code	6006779
Hospital Revenue Code	252
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$145.30
Rate for Payer: Aetna Commercial	$87.18
Rate for Payer: Aetna Medicare Advantage	$87.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.10
Rate for Payer: Cigna Commercial	$145.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.78
Rate for Payer: Oxford Commercial	$145.30
Rate for Payer: Qualcare PPO/HMO/WC	$43.59
Rate for Payer: UnitedHealthcare Commercial	$145.30

CHLORPACTIN VL

Facility

$21.15

Hospital Charge Code	6012363
Hospital Revenue Code	252
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

CHLORPACTIN VL

Facility

$21.15

Hospital Charge Code	6012363
Hospital Revenue Code	252
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

CHLORPHENIRAMINE 4 MG TAB

Facility

$2.45

Hospital Charge Code	60627221
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CHLORPHENIRAMINE 4 MG TAB

Facility

$2.45

Hospital Charge Code	60627221
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60634357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60634357
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

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632687
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632686
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

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632687
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

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPHENIRAM PHENYLEPH 118ML

Facility

$82.55

Hospital Charge Code	60627222
Hospital Revenue Code	251
Min. Negotiated Rate	$10.73
Max. Negotiated Rate	$41.27
Rate for Payer: Aetna Commercial	$24.77
Rate for Payer: Aetna Medicare Advantage	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.05
Rate for Payer: Cigna Commercial	$41.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.73
Rate for Payer: Oxford Commercial	$41.27
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$41.27

CHLORPHENIRAM PHENYLEPH 118ML

Facility

$82.55

Hospital Charge Code	60627222
Hospital Revenue Code	251
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

CHLORPHENIRAM PSEUDOEPH LQ

Facility

$37.80

Hospital Charge Code	6001168
Hospital Revenue Code	251
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

CHLORPHENIRAM PSEUDOEPH LQ

Facility

$37.80

Hospital Charge Code	6001168
Hospital Revenue Code	251
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

Know your out-of-pocket cost for care.

All Charges