Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLOZAPINE 100 MG TAB

Facility

$22.31

Service Code	NDC 93777201
Hospital Charge Code	60628808
Hospital Revenue Code	250
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$3.35

CLOZAPINE 100 MG TAB

Facility

$22.31

Service Code	NDC 93777201
Hospital Charge Code	60628808
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$6.69
Rate for Payer: Aetna Medicare Advantage	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.69
Rate for Payer: Cigna Commercial	$11.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$11.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.35
Rate for Payer: UnitedHealthcare Commercial	$11.15

CLOZAPINE 25 MG TAB

Facility

$38.79

Service Code	NDC 78012606
Hospital Charge Code	60628809
Hospital Revenue Code	250
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$5.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.82

CLOZAPINE 25 MG TAB

Facility

$38.79

Service Code	NDC 78012606
Hospital Charge Code	60628809
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$19.39
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.89
Rate for Payer: Cigna Commercial	$19.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.04
Rate for Payer: Oxford Commercial	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.82
Rate for Payer: UnitedHealthcare Commercial	$19.39

CLOZAPINE (CLOZARIL) SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007310
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

CLOZAPINE (CLOZARIL) SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007310
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CLOZARIL TAB 100MG

Facility

$37.80

Hospital Charge Code	6007488
Hospital Revenue Code	252
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

CLOZARIL TAB 100MG

Facility

$37.80

Hospital Charge Code	6007488
Hospital Revenue Code	252
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

CL REDUC TARSAL BONE,NO TALOTA

Facility

$645.00

Service Code	HCPCS 28540
Hospital Charge Code	5780110
Hospital Revenue Code	450
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CL REDUC TARSAL BONE,NO TALOTA

Facility

$645.00

Service Code	HCPCS 28540
Hospital Charge Code	5780110
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TALUS W/MANIP

Facility

$645.00

Service Code	HCPCS 28435
Hospital Charge Code	5780095
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TALUS W/MANIP

Facility

$645.00

Service Code	HCPCS 28435
Hospital Charge Code	5780095
Hospital Revenue Code	450
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TX CALCANEOUS W/MANIP

Facility

$8,519.00

Service Code	HCPCS 28405
Hospital Charge Code	5780090
Hospital Revenue Code	450
Min. Negotiated Rate	$1,277.85
Max. Negotiated Rate	$1,277.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,277.85

CLSD TX CALCANEOUS W/MANIP

Facility

$8,519.00

Service Code	HCPCS 28405
Hospital Charge Code	5780090
Hospital Revenue Code	450
Min. Negotiated Rate	$194.57
Max. Negotiated Rate	$2,555.70
Rate for Payer: Aetna Commercial	$2,555.70
Rate for Payer: Aetna Medicare Advantage	$2,555.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,172.34
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,107.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,277.85

CLSD TX GREATER HUM TUB W/MANI

Facility

$8,519.00

Service Code	HCPCS 23625
Hospital Charge Code	5780040
Hospital Revenue Code	450
Min. Negotiated Rate	$1,277.85
Max. Negotiated Rate	$1,277.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,277.85

CLSD TX GREATER HUM TUB W/MANI

Facility

$8,519.00

Service Code	HCPCS 23625
Hospital Charge Code	5780040
Hospital Revenue Code	450
Min. Negotiated Rate	$184.07
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,555.70
Rate for Payer: Aetna Medicare Advantage	$2,555.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,172.34
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,107.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,277.85

CLSD TX GRTR HUM TB FX W/SHOUL

Facility

$2,251.00

Service Code	HCPCS 23665
Hospital Charge Code	5780045
Hospital Revenue Code	450
Min. Negotiated Rate	$188.37
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$675.30
Rate for Payer: Aetna Medicare Advantage	$675.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$574.00
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.63
Rate for Payer: Qualcare PPO/HMO/WC	$337.65

CLSD TX GRTR HUM TB FX W/SHOUL

Facility

$2,251.00

Service Code	HCPCS 23665
Hospital Charge Code	5780045
Hospital Revenue Code	450
Min. Negotiated Rate	$337.65
Max. Negotiated Rate	$337.65
Rate for Payer: Qualcare PPO/HMO/WC	$337.65

CLSD TX METATARSAL W/MANIP

Facility

$645.00

Service Code	HCPCS 28475
Hospital Charge Code	5780105
Hospital Revenue Code	450
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TX METATARSAL W/MANIP

Facility

$645.00

Service Code	HCPCS 28475
Hospital Charge Code	5780105
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TX PATELLAR DISLOC W ANE

Facility

$2,666.00

Service Code	HCPCS 27562
Hospital Charge Code	5700832
Hospital Revenue Code	450
Min. Negotiated Rate	$150.28
Max. Negotiated Rate	$799.80
Rate for Payer: Aetna Commercial	$799.80
Rate for Payer: Aetna Medicare Advantage	$799.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$679.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$679.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$679.83
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.58
Rate for Payer: Qualcare PPO/HMO/WC	$399.90

CLSD TX PATELLAR DISLOC W ANE

Facility

$2,666.00

Service Code	HCPCS 27562
Hospital Charge Code	5700832
Hospital Revenue Code	450
Min. Negotiated Rate	$399.90
Max. Negotiated Rate	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$399.90

CLSD TX RADIAL HEAD/NECK W/MAN

Facility

$7,112.55

Service Code	HCPCS 24655
Hospital Charge Code	5780050
Hospital Revenue Code	450
Min. Negotiated Rate	$1,066.88
Max. Negotiated Rate	$1,066.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,066.88

CLSD TX RADIAL HEAD/NECK W/MAN

Facility

$7,112.55

Service Code	HCPCS 24655
Hospital Charge Code	5780050
Hospital Revenue Code	450
Min. Negotiated Rate	$147.31
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,133.76
Rate for Payer: Aetna Medicare Advantage	$2,133.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,813.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,813.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,813.70
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$924.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,066.88

CLSD TX TARSAL BONE W/MANIP

Facility

$645.00

Service Code	HCPCS 28455
Hospital Charge Code	5780100
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

Know your out-of-pocket cost for care.

All Charges