Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLONIDINE HCL PATCH 0.3MG

Facility

$518.31

Service Code	NDC 597003334
Hospital Charge Code	6001283
Hospital Revenue Code	250
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$259.15
Rate for Payer: Aetna Commercial	$155.49
Rate for Payer: Aetna Medicare Advantage	$155.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.17
Rate for Payer: Cigna Commercial	$259.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.38
Rate for Payer: Oxford Commercial	$259.15
Rate for Payer: Qualcare PPO/HMO/WC	$77.75
Rate for Payer: UnitedHealthcare Commercial	$259.15

CLONIDINE TAB 0.3MG

Facility

$3.85

Hospital Charge Code	60627626
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

CLONIDINE TAB 0.3MG

Facility

$3.85

Hospital Charge Code	60627626
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

CLOPIDOGREL 75 MG TAB

Facility

$26.80

Service Code	NDC 63653117103
Hospital Charge Code	60629140
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

CLOPIDOGREL 75 MG TAB

Facility

$26.80

Service Code	NDC 63653117103
Hospital Charge Code	60629140
Hospital Revenue Code	250
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.48
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$13.40

CLORAZEPATE 3.75 MG TAB

Facility

$6.40

Hospital Charge Code	6020085
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$3.20
Rate for Payer: Aetna Commercial	$1.92
Rate for Payer: Aetna Medicare Advantage	$1.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.63
Rate for Payer: Cigna Commercial	$3.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.83
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$3.20

CLORAZEPATE 3.75 MG TAB

Facility

$6.40

Hospital Charge Code	6020085
Hospital Revenue Code	251
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

CLORAZEPATE 3.75MG TAB

Facility

$13.60

Service Code	NDC 13107031901
Hospital Charge Code	6063943085
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.80
Rate for Payer: Aetna Commercial	$4.08
Rate for Payer: Aetna Medicare Advantage	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.47
Rate for Payer: Cigna Commercial	$6.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.04
Rate for Payer: UnitedHealthcare Commercial	$6.80

CLORAZEPATE 3.75MG TAB

Facility

$13.60

Service Code	NDC 13107031901
Hospital Charge Code	6063943085
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.04

CLORAZEPATE (TRANXENE) SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007311
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

CLORAZEPATE (TRANXENE) SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007311
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CLORTRIMAZOLE 1% CREAM 15 GM

Facility

$40.13

Service Code	NDC 45802043401
Hospital Charge Code	606351009
Hospital Revenue Code	250
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$6.02

CLORTRIMAZOLE 1% CREAM 15 GM

Facility

$40.13

Service Code	NDC 45802043401
Hospital Charge Code	606351009
Hospital Revenue Code	250
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$20.07
Rate for Payer: Aetna Commercial	$12.04
Rate for Payer: Aetna Medicare Advantage	$12.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.23
Rate for Payer: Cigna Commercial	$20.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.22
Rate for Payer: Oxford Commercial	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.02
Rate for Payer: UnitedHealthcare Commercial	$20.07

CLOSED CAMERA SYSTEM

Facility

$289.00

Hospital Charge Code	270656037
Hospital Revenue Code	271
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$144.50
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare Advantage	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.69
Rate for Payer: Cigna Commercial	$144.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.57
Rate for Payer: Oxford Commercial	$144.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.35
Rate for Payer: UnitedHealthcare Commercial	$144.50

CLOSED CAMERA SYSTEM

Facility

$289.00

Hospital Charge Code	270656037
Hospital Revenue Code	271
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$43.35
Rate for Payer: Qualcare PPO/HMO/WC	$43.35

CLOSED TX KNEE DISLOC W ANESTH

Facility

$12,366.06

Service Code	HCPCS 27552
Hospital Charge Code	323027552
Hospital Revenue Code	450
Min. Negotiated Rate	$1,854.91
Max. Negotiated Rate	$1,854.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,854.91

CLOSED TX KNEE DISLOC W ANESTH

Facility

$12,366.06

Service Code	HCPCS 27552
Hospital Charge Code	323027552
Hospital Revenue Code	450
Min. Negotiated Rate	$217.35
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$3,709.82
Rate for Payer: Aetna Medicare Advantage	$3,709.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,153.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,153.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,153.35
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,854.91

CLOSED TX SHOULDER DISLOCATION

Facility

$7,691.80

Service Code	HCPCS 23675
Hospital Charge Code	323023675
Hospital Revenue Code	450
Min. Negotiated Rate	$217.07
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,307.54
Rate for Payer: Aetna Medicare Advantage	$2,307.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,961.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,961.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,961.41
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.77

CLOSED TX SHOULDER DISLOCATION

Facility

$7,691.80

Service Code	HCPCS 23675
Hospital Charge Code	323023675
Hospital Revenue Code	450
Min. Negotiated Rate	$1,153.77
Max. Negotiated Rate	$1,153.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.77

CLOSED TX STERNUM W/O MANIP

Facility

$906.60

Service Code	HCPCS 21820
Hospital Charge Code	5700728
Hospital Revenue Code	450
Min. Negotiated Rate	$50.09
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$271.98
Rate for Payer: Aetna Medicare Advantage	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.18
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.86
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

CLOSED TX STERNUM W/O MANIP

Facility

$906.60

Service Code	HCPCS 21820
Hospital Charge Code	5700728
Hospital Revenue Code	450
Min. Negotiated Rate	$135.99
Max. Negotiated Rate	$135.99
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

CLOSESURE SYSTEM CARTER THOMAS

Facility

$675.00

Hospital Charge Code	270674140
Hospital Revenue Code	272
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.75
Rate for Payer: Oxford Commercial	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Commercial	$337.50

CLOSESURE SYSTEM CARTER THOMAS

Facility

$675.00

Hospital Charge Code	270674140
Hospital Revenue Code	272
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

CLOSEUREFAST 6F CATHETER

Facility

$5,775.00

Hospital Charge Code	270703632
Hospital Revenue Code	272
Min. Negotiated Rate	$750.75
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$1,732.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.75
Rate for Payer: Oxford Commercial	$2,887.50
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Commercial	$2,887.50

CLOSEUREFAST 6F CATHETER

Facility

$5,775.00

Hospital Charge Code	270703632
Hospital Revenue Code	272
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$866.25
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

Know your out-of-pocket cost for care.

All Charges