Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHLORTHALIDONE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORTHALIDONE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634315
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

CHLORTHALIDONE/25MG/UD/TA

Facility

$3.00

Hospital Charge Code	60634661
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

CHLORTHALIDONE/25MG/UD/TA

Facility

$3.00

Hospital Charge Code	60634661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORTHALIDONE 50 MG TAB

Facility

$9.98

Service Code	NDC 378021301
Hospital Charge Code	60627963
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

CHLORTHALIDONE 50 MG TAB

Facility

$9.98

Service Code	NDC 378021301
Hospital Charge Code	60627963
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$4.99
Rate for Payer: Aetna Commercial	$2.99
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.54
Rate for Payer: Cigna Commercial	$4.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$4.99

CHLORTHALIDONE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60632696
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

CHLORTHALIDONE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60632696
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORZOXAZONE TAB 500MG

Facility

$4.50

Hospital Charge Code	60627481
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

CHLORZOXAZONE TAB 500MG

Facility

$4.50

Hospital Charge Code	60627481
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

CH L/S RATIO

Facility

$336.00

Service Code	HCPCS 83661
Hospital Charge Code	397071342
Hospital Revenue Code	301
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

CH L/S RATIO

Facility

$336.00

Service Code	HCPCS 83661
Hospital Charge Code	397071342
Hospital Revenue Code	301
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.57
Rate for Payer: Cigna Commercial	$21.99
Rate for Payer: Cigna Medicare Advantage	$10.99
Rate for Payer: Clover Medicare Advantage	$20.89
Rate for Payer: EmblemHealth Commercial	$65.97
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.31
Rate for Payer: Wellcare Medicare Advantage	$21.99

CH LUPUS ANTICOAGDRVVT WREFL

Facility

$255.00

Service Code	HCPCS 85613
Hospital Charge Code	397073648
Hospital Revenue Code	305
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.04
Rate for Payer: Aetna Medicare Advantage	$9.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.10
Rate for Payer: Cigna Commercial	$9.58
Rate for Payer: Cigna Medicare Advantage	$4.79
Rate for Payer: Clover Medicare Advantage	$9.10
Rate for Payer: EmblemHealth Commercial	$28.74
Rate for Payer: Humana Medicare Advantage	$9.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.15
Rate for Payer: Wellcare Medicare Advantage	$9.58

CH LUPUS ANTICOAGDRVVT WREFL

Facility

$255.00

Service Code	HCPCS 85613
Hospital Charge Code	397073648
Hospital Revenue Code	305
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$38.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

CH LUPUS ANTICOAG HEXA PHASE

Facility

$356.00

Service Code	HCPCS 85597
Hospital Charge Code	397073647
Hospital Revenue Code	305
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

CH LUPUS ANTICOAG HEXA PHASE

Facility

$356.00

Service Code	HCPCS 85597
Hospital Charge Code	397073647
Hospital Revenue Code	305
Min. Negotiated Rate	$53.40
Max. Negotiated Rate	$53.40
Rate for Payer: Qualcare PPO/HMO/WC	$53.40

CH LUPUS ANTI-COAGULANT

Facility

$263.57

Service Code	HCPCS 85730
Hospital Charge Code	397072103
Hospital Revenue Code	305
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.47
Rate for Payer: Aetna Medicare Advantage	$6.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.02
Rate for Payer: Cigna Commercial	$6.01
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.54
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.37
Rate for Payer: Wellcare Medicare Advantage	$6.01

CH LUPUS ANTI-COAGULANT

Facility

$263.57

Service Code	HCPCS 85730
Hospital Charge Code	397072103
Hospital Revenue Code	305
Min. Negotiated Rate	$39.54
Max. Negotiated Rate	$39.54
Rate for Payer: Qualcare PPO/HMO/WC	$39.54

CH LUTEINIZING HORMONE

Facility

$390.00

Service Code	HCPCS 83002
Hospital Charge Code	397071055
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.86
Rate for Payer: Cigna Commercial	$18.52
Rate for Payer: Cigna Medicare Advantage	$9.26
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.63
Rate for Payer: Wellcare Medicare Advantage	$18.52

CH LUTEINIZING HORMONE

Facility

$390.00

Service Code	HCPCS 83002
Hospital Charge Code	397071055
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH LYME AB IGM

Facility

$667.59

Service Code	HCPCS 86618
Hospital Charge Code	397041186
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH LYME AB IGM

Facility

$667.59

Service Code	HCPCS 86618
Hospital Charge Code	397041186
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

CH LYME PCR

Facility

$828.00

Service Code	HCPCS 87476
Hospital Charge Code	397071354
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

CH LYME PCR

Facility

$828.00

Service Code	HCPCS 87476
Hospital Charge Code	397071354
Hospital Revenue Code	306
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$124.20
Rate for Payer: Qualcare PPO/HMO/WC	$124.20

CH LYME PCR CSF

Facility

$784.00

Service Code	HCPCS 87476
Hospital Charge Code	397073341
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

Know your out-of-pocket cost for care.

All Charges