Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLOTH BARRIER 3% CREAM

Facility

$12.42

Hospital Charge Code	270663233
Hospital Revenue Code	270
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$6.21
Rate for Payer: Aetna Commercial	$3.73
Rate for Payer: Aetna Medicare Advantage	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.17
Rate for Payer: Cigna Commercial	$6.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$6.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$6.21

CLOTH BARRIER 3% CREAM

Facility

$12.42

Hospital Charge Code	270663233
Hospital Revenue Code	270
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

CLOT INHIBIT PROT C ACTIVITY

Facility

$390.00

Service Code	HCPCS 85303
Hospital Charge Code	401485303
Hospital Revenue Code	305
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.71
Rate for Payer: Cigna Commercial	$13.84
Rate for Payer: Cigna Medicare Advantage	$6.92
Rate for Payer: Clover Medicare Advantage	$13.15
Rate for Payer: EmblemHealth Commercial	$41.52
Rate for Payer: Humana Medicare Advantage	$14.26
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	$13.84
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.67
Rate for Payer: Wellcare Medicare Advantage	$13.84

CLOT INHIBIT PROT C ACTIVITY

Facility

$390.00

Service Code	HCPCS 85303
Hospital Charge Code	401485303
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT C ANTIGEN

Facility

$390.00

Service Code	HCPCS 85302
Hospital Charge Code	401485302
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT C ANTIGEN

Facility

$390.00

Service Code	HCPCS 85302
Hospital Charge Code	401485302
Hospital Revenue Code	305
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.00
Rate for Payer: Cigna Commercial	$12.01
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
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	$12.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.01

CLOT INHIBIT PROT S FREE

Facility

$390.00

Service Code	HCPCS 85306
Hospital Charge Code	401485306
Hospital Revenue Code	305
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.64
Rate for Payer: Aetna Medicare Advantage	$15.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.13
Rate for Payer: Cigna Commercial	$15.32
Rate for Payer: Cigna Medicare Advantage	$7.66
Rate for Payer: Clover Medicare Advantage	$14.55
Rate for Payer: EmblemHealth Commercial	$45.96
Rate for Payer: Humana Medicare Advantage	$15.78
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	$15.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.24
Rate for Payer: Wellcare Medicare Advantage	$15.32

CLOT INHIBIT PROT S FREE

Facility

$390.00

Service Code	HCPCS 85306
Hospital Charge Code	401485306
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT S TOTAL

Facility

$390.00

Service Code	HCPCS 85305
Hospital Charge Code	401485305
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT S TOTAL

Facility

$390.00

Service Code	HCPCS 85305
Hospital Charge Code	401485305
Hospital Revenue Code	305
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.54
Rate for Payer: Cigna Commercial	$11.61
Rate for Payer: Cigna Medicare Advantage	$5.80
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
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	$11.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.31
Rate for Payer: Wellcare Medicare Advantage	$11.61

CLOT RETRACTION***

Facility

$18.00

Hospital Charge Code	3010824
Hospital Revenue Code	309
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

CLOT RETRACTION***

Facility

$18.00

Hospital Charge Code	3010824
Hospital Revenue Code	309
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

CLOT RETRACTION TIME

Facility

$63.25

Service Code	HCPCS 85170
Hospital Charge Code	3000825
Hospital Revenue Code	305
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

CLOT RETRACTION TIME

Facility

$63.25

Service Code	HCPCS 85170
Hospital Charge Code	3000825
Hospital Revenue Code	305
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.81
Rate for Payer: Aetna Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.72
Rate for Payer: Cigna Commercial	$16.30
Rate for Payer: Cigna Medicare Advantage	$8.15
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.28
Rate for Payer: Wellcare Medicare Advantage	$16.30

CLOTRIMAZOLE 10 MG TROCHE

Facility

$9.78

Service Code	NDC 574010714
Hospital Charge Code	60628336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

CLOTRIMAZOLE 10 MG TROCHE

Facility

$9.78

Service Code	NDC 574010714
Hospital Charge Code	60628336
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$4.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$4.89

CLOTRIMAZOLE 1 % CRE

Facility

$57.55

Service Code	NDC 45802043411
Hospital Charge Code	60628334
Hospital Revenue Code	250
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$8.63
Rate for Payer: Qualcare PPO/HMO/WC	$8.63

CLOTRIMAZOLE 1 % CRE

Facility

$57.55

Service Code	NDC 45802043411
Hospital Charge Code	60628334
Hospital Revenue Code	250
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$28.77
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.68
Rate for Payer: Cigna Commercial	$28.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: Oxford Commercial	$28.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.63
Rate for Payer: UnitedHealthcare Commercial	$28.77

CLOTRIMAZOLE 1% TOP SOLN

Facility

$302.37

Service Code	NDC 93024843
Hospital Charge Code	60628335
Hospital Revenue Code	250
Min. Negotiated Rate	$39.31
Max. Negotiated Rate	$151.19
Rate for Payer: Aetna Commercial	$90.71
Rate for Payer: Aetna Medicare Advantage	$90.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.10
Rate for Payer: Cigna Commercial	$151.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.31
Rate for Payer: Oxford Commercial	$151.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.36
Rate for Payer: UnitedHealthcare Commercial	$151.19

CLOTRIMAZOLE 1% TOP SOLN

Facility

$302.37

Service Code	NDC 93024843
Hospital Charge Code	60628335
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$45.36
Rate for Payer: Qualcare PPO/HMO/WC	$45.36

CLOTRIMAZOLE 1% VAGINAL CREAM

Facility

$80.40

Service Code	NDC 472022041
Hospital Charge Code	60628963
Hospital Revenue Code	251
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$40.20
Rate for Payer: Aetna Commercial	$24.12
Rate for Payer: Aetna Medicare Advantage	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.50
Rate for Payer: Cigna Commercial	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.45
Rate for Payer: Oxford Commercial	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.06
Rate for Payer: UnitedHealthcare Commercial	$40.20

CLOTRIMAZOLE 1% VAGINAL CREAM

Facility

$80.40

Service Code	NDC 472022041
Hospital Charge Code	60628963
Hospital Revenue Code	251
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

CLOTRIMAZOLE 30 GM

Facility

$8.40

Hospital Charge Code	60628334W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Qualcare PPO/HMO/WC	$1.26

CLOTRIMAZOLE 30 GM

Facility

$8.40

Hospital Charge Code	60628334W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$4.20
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna Medicare Advantage	$2.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.14
Rate for Payer: Cigna Commercial	$4.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.09
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.26
Rate for Payer: UnitedHealthcare Commercial	$4.20

CLOTRIMAZOLE CRM 30GM

Facility

$131.85

Hospital Charge Code	6001317
Hospital Revenue Code	251
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

Know your out-of-pocket cost for care.

All Charges