Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLINDAMYCIN PHOSPHATE 2 % CRE

Facility

$900.35

Service Code	NDC 9344801
Hospital Charge Code	6011068
Hospital Revenue Code	250
Min. Negotiated Rate	$117.05
Max. Negotiated Rate	$450.18
Rate for Payer: Aetna Commercial	$270.11
Rate for Payer: Aetna Medicare Advantage	$270.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.59
Rate for Payer: Cigna Commercial	$450.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.05
Rate for Payer: Oxford Commercial	$450.18
Rate for Payer: Qualcare PPO/HMO/WC	$135.05
Rate for Payer: UnitedHealthcare Commercial	$450.18

CLINDAMYCIN VAG CRM 2% 40G

Facility

$309.15

Hospital Charge Code	6010284
Hospital Revenue Code	252
Min. Negotiated Rate	$46.37
Max. Negotiated Rate	$46.37
Rate for Payer: Qualcare PPO/HMO/WC	$46.37

CLINDAMYCIN VAG CRM 2% 40G

Facility

$309.15

Hospital Charge Code	6010284
Hospital Revenue Code	252
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$154.57
Rate for Payer: Aetna Commercial	$92.75
Rate for Payer: Aetna Medicare Advantage	$92.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.83
Rate for Payer: Cigna Commercial	$154.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.19
Rate for Payer: Oxford Commercial	$154.57
Rate for Payer: Qualcare PPO/HMO/WC	$46.37
Rate for Payer: UnitedHealthcare Commercial	$154.57

CLINICAL CHEMISTRY TEST

Facility

$760.50

Service Code	HCPCS 84999
Hospital Charge Code	401084999
Hospital Revenue Code	301
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

CLINICAL CHEMISTRY TEST

Facility

$760.50

Service Code	HCPCS 84999
Hospital Charge Code	401084999
Hospital Revenue Code	301
Min. Negotiated Rate	$98.86
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$228.15
Rate for Payer: Aetna Medicare Advantage	$228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.93
Rate for Payer: Cigna Commercial	$380.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$114.00

CLINIMIX 4.25/5,2000ML

Facility

$160.00

Hospital Charge Code	60635450
Hospital Revenue Code	250
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

CLINIMIX 4.25/5,2000ML

Facility

$160.00

Hospital Charge Code	60635450
Hospital Revenue Code	250
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$80.00

CLINIMIX 4.25/D25W,PLAIN

Facility

$44.00

Hospital Charge Code	60635424
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

CLINIMIX 4.25/D25W,PLAIN

Facility

$44.00

Hospital Charge Code	60635424
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CLINIMIX,4.25% LYTES,BOT

Facility

$44.00

Hospital Charge Code	60635425
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CLINIMIX,4.25% LYTES,BOT

Facility

$44.00

Hospital Charge Code	60635425
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

CLINIMIX 5/25,5% 2000ML

Facility

$45.00

Hospital Charge Code	60635452
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

CLINIMIX 5/25,5% 2000ML

Facility

$45.00

Hospital Charge Code	60635452
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

CLINIMIX E 5/25,2000ML

Facility

$45.00

Hospital Charge Code	60635451
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

CLINIMIX E 5/25,2000ML

Facility

$45.00

Hospital Charge Code	60635451
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

CLINORIL/150MG/TAB

Facility

$9.00

Hospital Charge Code	60632711
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CLINORIL/150MG/TAB

Facility

$8.00

Hospital Charge Code	60632713
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CLINORIL/150MG/TAB

Facility

$8.00

Hospital Charge Code	60632713
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

CLINORIL/150MG/TAB

Facility

$9.00

Hospital Charge Code	60632711
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

CLINORIL/200MG/TAB

Facility

$7.00

Hospital Charge Code	60632712
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

CLINORIL/200MG/TAB

Facility

$7.00

Hospital Charge Code	60632714
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CLINORIL/200MG/TAB

Facility

$7.00

Hospital Charge Code	60632712
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CLINORIL/200MG/TAB

Facility

$7.00

Hospital Charge Code	60632714
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

CLINOXIDE/CAP

Facility

$3.00

Hospital Charge Code	60632715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CLINOXIDE/CAP

Facility

$3.00

Hospital Charge Code	60632715
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

Know your out-of-pocket cost for care.

All Charges