Heights University Hospital

All Charges

Charge

Type

Setting

Price

CYANOCOBALAMIN 500MCG TAB

Facility

$4.00

Service Code	NDC 904320713
Hospital Charge Code	6063943090
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYANOCOBALAMIN 500MCG TAB

Facility

$4.00

Service Code	NDC 904320713
Hospital Charge Code	6063943090
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

CYANOCOBALAMIN INJ 1MG/VIAL

Facility

$3.85

Hospital Charge Code	6027213
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

CYANOCOBALAMIN INJ 1MG/VIAL

Facility

$3.85

Hospital Charge Code	6027213
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

Cyanokit 5g vial (Hydroxocobal

Facility

$5,502.84

Service Code	NDC 11704037001
Hospital Charge Code	606351012
Hospital Revenue Code	250
Min. Negotiated Rate	$825.43
Max. Negotiated Rate	$825.43
Rate for Payer: Qualcare PPO/HMO/WC	$825.43

Cyanokit 5g vial (Hydroxocobal

Facility

$5,502.84

Service Code	NDC 11704037001
Hospital Charge Code	606351012
Hospital Revenue Code	250
Min. Negotiated Rate	$715.37
Max. Negotiated Rate	$2,751.42
Rate for Payer: Aetna Commercial	$1,650.85
Rate for Payer: Aetna Medicare Advantage	$1,650.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,403.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,403.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,403.22
Rate for Payer: Cigna Commercial	$2,751.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.37
Rate for Payer: Oxford Commercial	$2,751.42
Rate for Payer: Qualcare PPO/HMO/WC	$825.43
Rate for Payer: UnitedHealthcare Commercial	$2,751.42

CYCLANDELATE/400MG/CAP

Facility

$3.00

Hospital Charge Code	60632761
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

CYCLANDELATE/400MG/CAP

Facility

$3.00

Hospital Charge Code	60632761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CYCLIC AMP

Facility

$391.00

Service Code	HCPCS 82090
Hospital Charge Code	38473068
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

CYCLIC AMP

Facility

$391.00

Service Code	HCPCS 82090
Hospital Charge Code	38473068
Hospital Revenue Code	301
Min. Negotiated Rate	$50.83
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$117.30
Rate for Payer: Aetna Medicare Advantage	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

CYCLIC AMP, PLASMA

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3038107
Hospital Revenue Code	307
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$83.59
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.53
Rate for Payer: Cigna Commercial	$25.80
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.35
Rate for Payer: Wellcare Medicare Advantage	$25.80

CYCLIC AMP, PLASMA

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3038107
Hospital Revenue Code	307
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.50

CYCLIC AMP,URINE

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3032061B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

CYCLIC AMP,URINE

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3032061A
Hospital Revenue Code	307
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.50

CYCLIC AMP,URINE

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3032061B
Hospital Revenue Code	301
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$22.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.90

CYCLIC AMP,URINE

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3032061A
Hospital Revenue Code	307
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$83.59
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.53
Rate for Payer: Cigna Commercial	$25.80
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.35
Rate for Payer: Wellcare Medicare Advantage	$25.80

CYCLIC CITRULLINATE PEP IGG

Facility

$128.00

Service Code	HCPCS 86200
Hospital Charge Code	3009984
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CYCLIC CITRULLINATE PEP IGG

Facility

$128.00

Service Code	HCPCS 86200
Hospital Charge Code	3009984
Hospital Revenue Code	302
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.96
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.45
Rate for Payer: Cigna Commercial	$12.95
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.73
Rate for Payer: Wellcare Medicare Advantage	$12.95

CYCLIC CITRULLINE PEP IGG

Facility

$89.00

Service Code	HCPCS 86200
Hospital Charge Code	39900198
Hospital Revenue Code	302
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.96
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.45
Rate for Payer: Cigna Commercial	$12.95
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.73
Rate for Payer: Wellcare Medicare Advantage	$12.95

CYCLIC CITRULLINE PEP IGG

Facility

$89.00

Service Code	HCPCS 86200
Hospital Charge Code	39900198
Hospital Revenue Code	302
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

CYCLIC CITRU PEPTIDE AB

Facility

$91.70

Service Code	HCPCS 86200
Hospital Charge Code	38478107
Hospital Revenue Code	300
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.96
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.45
Rate for Payer: Cigna Commercial	$12.95
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.76
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.73
Rate for Payer: Wellcare Medicare Advantage	$12.95

CYCLIC CITRU PEPTIDE AB

Facility

$91.70

Service Code	HCPCS 86200
Hospital Charge Code	38478107
Hospital Revenue Code	300
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$13.76
Rate for Payer: Qualcare PPO/HMO/WC	$13.76

CYCLOBENZAPRINE 10 MG TAB

Facility

$6.50

Service Code	NDC 51079064420
Hospital Charge Code	60627482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$1.95
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.85
Rate for Payer: Oxford Commercial	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$3.25

CYCLOBENZAPRINE 10 MG TAB

Facility

$6.50

Service Code	NDC 51079064420
Hospital Charge Code	60627482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

CYCLOBENZAPRINE 5 MG TABLET

Facility

$4.95

Hospital Charge Code	60629309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Qualcare PPO/HMO/WC	$0.74

Know your out-of-pocket cost for care.

All Charges