Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLARITHROMYCN SSP .125MG/5ML

Facility

$62.10

Hospital Charge Code	6017412
Hospital Revenue Code	252
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

CLARITHROMYCN SSP .125MG/5ML

Facility

$62.10

Hospital Charge Code	6017412
Hospital Revenue Code	252
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

CLARITHROMYCN SSP .250MG/5ML

Facility

$115.85

Hospital Charge Code	6017404
Hospital Revenue Code	252
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$57.92
Rate for Payer: Aetna Commercial	$34.76
Rate for Payer: Aetna Medicare Advantage	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.54
Rate for Payer: Cigna Commercial	$57.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.06
Rate for Payer: Oxford Commercial	$57.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.38
Rate for Payer: UnitedHealthcare Commercial	$57.92

CLARITHROMYCN SSP .250MG/5ML

Facility

$115.85

Hospital Charge Code	6017404
Hospital Revenue Code	252
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$17.38
Rate for Payer: Qualcare PPO/HMO/WC	$17.38

CLARITHROMYCN SSP 250MG/5ML50M

Facility

$12.19

Service Code	NDC 74318850
Hospital Charge Code	6017388
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

CLARITHROMYCN SSP 250MG/5ML50M

Facility

$12.19

Service Code	NDC 74318850
Hospital Charge Code	6017388
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$3.66
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.58
Rate for Payer: Oxford Commercial	$6.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$6.09

CLARITIN 10MG

Facility

$42.21

Service Code	NDC 990713909
Hospital Charge Code	60635543
Hospital Revenue Code	250
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

CLARITIN 10MG

Facility

$42.21

Service Code	NDC 990713909
Hospital Charge Code	60635543
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$21.11
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna Medicare Advantage	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.76
Rate for Payer: Cigna Commercial	$21.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.49
Rate for Payer: Oxford Commercial	$21.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.33
Rate for Payer: UnitedHealthcare Commercial	$21.11

CLARITIN 1MG/ML ORAL SOLN

Facility

$9.45

Service Code	NDC 49999025004
Hospital Charge Code	6063943290
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.42

CLARITIN 1MG/ML ORAL SOLN

Facility

$9.45

Service Code	NDC 49999025004
Hospital Charge Code	6063943290
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.41
Rate for Payer: Cigna Commercial	$4.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.23
Rate for Payer: Oxford Commercial	$4.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.42
Rate for Payer: UnitedHealthcare Commercial	$4.72

CLARIX FLO PARTICULATE 25MG

Facility

$2,000.00

Service Code	HCPCS Q4155
Hospital Charge Code	270677072
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CLARIX FLO PARTICULATE 25MG

Facility

$2,000.00

Service Code	HCPCS Q4155
Hospital Charge Code	270677072
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CLASSIC ERCP CATHETER

Facility

$43.00

Hospital Charge Code	270325608
Hospital Revenue Code	272
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

CLASSIC ERCP CATHETER

Facility

$43.00

Hospital Charge Code	270325608
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

CLASS II & ABOVE, PAP SMEARS

Facility

$143.00

Service Code	HCPCS 88141
Hospital Charge Code	38474097
Hospital Revenue Code	311
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.47
Rate for Payer: Cigna Commercial	$27.06
Rate for Payer: Cigna Medicare Advantage	$13.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.45
Rate for Payer: UnitedHealthcare Commercial	$114.00

CLASS II & ABOVE, PAP SMEARS

Facility

$143.00

Service Code	HCPCS 88141
Hospital Charge Code	38474097
Hospital Revenue Code	311
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$21.45

CLAVE EXTENSION SET

Facility

$5.43

Hospital Charge Code	270650169
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$2.71

CLAVE EXTENSION SET

Facility

$5.43

Hospital Charge Code	270650169
Hospital Revenue Code	270
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

CLAVE PORT PLUG MALE ADAPTER

Facility

$5.45

Hospital Charge Code	270649368
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.82

CLAVE PORT PLUG MALE ADAPTER

Facility

$5.45

Hospital Charge Code	270649368
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.73
Rate for Payer: Aetna Commercial	$1.64
Rate for Payer: Aetna Medicare Advantage	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.39
Rate for Payer: Cigna Commercial	$2.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.82
Rate for Payer: UnitedHealthcare Commercial	$2.73

CLAVICLE COMPL-BILAT

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	94061209
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

CLAVICLE COMPL-BILAT

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	94061209
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLAVICLE COMPL-LT

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	94061277
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLAVICLE COMPL-LT

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	94061277
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

CLAVICLE COMPL-RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	94061279
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

Know your out-of-pocket cost for care.

All Charges