Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

CLOTRIMAZOLE CRM VAG 45GM

Facility

$122.25

Hospital Charge Code	6001291
Hospital Revenue Code	251
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$36.67
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Oxford Commercial	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$61.12

CLOTRIMAZOLE CRM VAG 45GM

Facility

$122.25

Hospital Charge Code	6001291
Hospital Revenue Code	251
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

CLOTRIMAZOLE TAB VAG 100MG

Facility

$21.15

Hospital Charge Code	6001309
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

CLOTRIMAZOLE TAB VAG 100MG

Facility

$21.15

Hospital Charge Code	6001309
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

CLOTTIN FACTR VIII VON WILLEBR

Facility

$162.50

Service Code	HCPCS 85247
Hospital Charge Code	38477172
Hospital Revenue Code	305
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$24.38

CLOTTIN FACTR VIII VON WILLEBR

Facility

$162.50

Service Code	HCPCS 85247
Hospital Charge Code	38477172
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

CLOTTING FACTOR XIII FIBRIN ST

Facility

$66.00

Service Code	HCPCS 85291
Hospital Charge Code	38477056
Hospital Revenue Code	305
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CLOTTING FACTOR XIII FIBRIN ST

Facility

$66.00

Service Code	HCPCS 85291
Hospital Charge Code	38477056
Hospital Revenue Code	305
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.52
Rate for Payer: Aetna Medicare Advantage	$9.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.38
Rate for Payer: Cigna Commercial	$9.11
Rate for Payer: Cigna Medicare Advantage	$4.55
Rate for Payer: Clover Medicare Advantage	$8.65
Rate for Payer: EmblemHealth Commercial	$27.33
Rate for Payer: Humana Medicare Advantage	$9.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.66
Rate for Payer: Wellcare Medicare Advantage	$9.11

CLOTTING INH/ANTICOAG PROT C

Facility

$97.95

Service Code	HCPCS 85303
Hospital Charge Code	38477120
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	$12.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.69
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

CLOTTING INH/ANTICOAG PROT C

Facility

$97.95

Service Code	HCPCS 85303
Hospital Charge Code	38477120
Hospital Revenue Code	305
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$14.69
Rate for Payer: Qualcare PPO/HMO/WC	$14.69

CLOTTING INH/ANTICOAG PROTEIN

Facility

$108.50

Service Code	HCPCS 85306
Hospital Charge Code	38477130
Hospital Revenue Code	305
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$16.27

CLOTTING INH/ANTICOAG PROTEIN

Facility

$108.50

Service Code	HCPCS 85306
Hospital Charge Code	38477130
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	$14.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.27
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

CLOTTRIEVER SYSTEM

Facility

$45,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270697175
Hospital Revenue Code	278
Min. Negotiated Rate	$6,750.00
Max. Negotiated Rate	$22,500.00
Rate for Payer: Aetna Commercial	$13,500.00
Rate for Payer: Aetna Medicare Advantage	$13,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,475.00
Rate for Payer: Cigna Commercial	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,890.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,750.00

CLOTTRIEVER SYSTEM

Facility

$45,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270697175
Hospital Revenue Code	278
Min. Negotiated Rate	$6,750.00
Max. Negotiated Rate	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,890.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,750.00

CLOURSE DEVICE CELT 5F

Facility

$5,000.00

Hospital Charge Code	270705360
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CLOURSE DEVICE CELT 5F

Facility

$5,000.00

Hospital Charge Code	270705360
Hospital Revenue Code	279
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

CLOURSE DEVICE CELT 6F

Facility

$5,000.00

Hospital Charge Code	270705361
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CLOURSE DEVICE CELT 6F

Facility

$5,000.00

Hospital Charge Code	270705361
Hospital Revenue Code	279
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

CLOURSE DEVICE CELT 7F

Facility

$5,000.00

Hospital Charge Code	270705362
Hospital Revenue Code	279
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

CLOURSE DEVICE CELT 7F

Facility

$5,000.00

Hospital Charge Code	270705362
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CLOVERLEAF 3-HOLE 2452-088-03

Facility

$422.45

Hospital Charge Code	270610281
Hospital Revenue Code	272
Min. Negotiated Rate	$63.37
Max. Negotiated Rate	$63.37
Rate for Payer: Qualcare PPO/HMO/WC	$63.37

CLOVERLEAF 3-HOLE 2452-088-03

Facility

$422.45

Hospital Charge Code	270610281
Hospital Revenue Code	272
Min. Negotiated Rate	$54.92
Max. Negotiated Rate	$211.22
Rate for Payer: Aetna Commercial	$126.73
Rate for Payer: Aetna Medicare Advantage	$126.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.72
Rate for Payer: Cigna Commercial	$211.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.92
Rate for Payer: Oxford Commercial	$211.22
Rate for Payer: Qualcare PPO/HMO/WC	$63.37
Rate for Payer: UnitedHealthcare Commercial	$211.22

CLOZAPINE

Facility

$390.00

Service Code	HCPCS 80159
Hospital Charge Code	39900480
Hospital Revenue Code	301
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.29
Rate for Payer: Aetna Medicare Advantage	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.83
Rate for Payer: Cigna Commercial	$20.15
Rate for Payer: Cigna Medicare Advantage	$10.07
Rate for Payer: Clover Medicare Advantage	$19.14
Rate for Payer: EmblemHealth Commercial	$60.45
Rate for Payer: Humana Medicare Advantage	$20.75
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	$20.15
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.36
Rate for Payer: Wellcare Medicare Advantage	$20.15

CLOZAPINE

Facility

$390.00

Service Code	HCPCS 80159
Hospital Charge Code	39900480
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges