Heights University Hospital

All Charges

Charge

Type

Setting

Price

CYCLOPHOSPHAMIDE 25 MG TAB

Facility

$62.71

Service Code	HCPCS J8530
Hospital Charge Code	60627372
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$18.81
Rate for Payer: Aetna Commercial	$18.81
Rate for Payer: Aetna Medicare Advantage	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.99
Rate for Payer: Cigna Commercial	$1.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.18
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

CYCLOPHOSPHAMIDE 25 MG TAB

Facility

$62.71

Service Code	HCPCS J8530
Hospital Charge Code	60627372
Hospital Revenue Code	636
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$15.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.18
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

CYCLOPHOSPHAMIDE 500/MG

Facility

$155.00

Hospital Charge Code	60632771
Hospital Revenue Code	636
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$46.50
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

CYCLOPHOSPHAMIDE 500/MG

Facility

$155.00

Hospital Charge Code	60632771
Hospital Revenue Code	636
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

CYCLOPHOSPHAMIDE 500 MG INJ

Facility

$2,944.65

Service Code	HCPCS J9070
Hospital Charge Code	6001515
Hospital Revenue Code	636
Min. Negotiated Rate	$441.70
Max. Negotiated Rate	$712.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.61
Rate for Payer: Qualcare PPO/HMO/WC	$441.70

CYCLOPHOSPHAMIDE 500 MG INJ

Facility

$2,944.65

Service Code	HCPCS J9070
Hospital Charge Code	6001515
Hospital Revenue Code	636
Min. Negotiated Rate	$441.70
Max. Negotiated Rate	$1,472.33
Rate for Payer: Aetna Commercial	$883.39
Rate for Payer: Aetna Medicare Advantage	$883.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.89
Rate for Payer: Cigna Commercial	$1,472.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.61
Rate for Payer: Qualcare PPO/HMO/WC	$441.70

CYCLOPHOSPHAMIDE INJ 200MG

Facility

$35.85

Hospital Charge Code	6001507
Hospital Revenue Code	250
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$17.93
Rate for Payer: Aetna Commercial	$10.76
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.66
Rate for Payer: Oxford Commercial	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.38
Rate for Payer: UnitedHealthcare Commercial	$17.93

CYCLOPHOSPHAMIDE INJ 200MG

Facility

$35.85

Hospital Charge Code	6001507
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

CYCLOSPASMOL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634366
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CYCLOSPASMOL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634366
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

CYCLOSPORA

Facility

$142.00

Service Code	HCPCS 87015
Hospital Charge Code	38475103
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

CYCLOSPORA

Facility

$142.00

Service Code	HCPCS 87015
Hospital Charge Code	38475103
Hospital Revenue Code	309
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CYCLOSPORA ID I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39990111A
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
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	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

CYCLOSPORA ID I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39990111A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYCLOSPORA ID II

Facility

$390.00

Service Code	HCPCS 87207
Hospital Charge Code	39990111B
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
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	$21.95
Rate for Payer: Cigna Commercial	$5.99
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
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	$5.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.35
Rate for Payer: Wellcare Medicare Advantage	$5.99

CYCLOSPORA ID II

Facility

$390.00

Service Code	HCPCS 87207
Hospital Charge Code	39990111B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYCLOSPORA & ISOSPORA 1

Facility

$146.00

Service Code	HCPCS 87015
Hospital Charge Code	3035083A
Hospital Revenue Code	300
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

CYCLOSPORA & ISOSPORA 1

Facility

$146.00

Service Code	HCPCS 87015
Hospital Charge Code	3035083A
Hospital Revenue Code	300
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

CYCLOSPORA & ISOSPORA 2

Facility

$78.00

Service Code	HCPCS 87207
Hospital Charge Code	3035083B
Hospital Revenue Code	300
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CYCLOSPORA & ISOSPORA 2

Facility

$78.00

Service Code	HCPCS 87207
Hospital Charge Code	3035083B
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
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	$21.95
Rate for Payer: Cigna Commercial	$5.99
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.35
Rate for Payer: Wellcare Medicare Advantage	$5.99

CYCLOSPORIN 100/MG TAB

Facility

$32.00

Hospital Charge Code	60635071
Hospital Revenue Code	636
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CYCLOSPORIN 100/MG TAB

Facility

$32.00

Hospital Charge Code	60635071
Hospital Revenue Code	636
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$7.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CYCLOSPORINE 100 MG CAP

Facility

$71.62

Service Code	HCPCS J7502
Hospital Charge Code	6001531
Hospital Revenue Code	636
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$21.49
Rate for Payer: Aetna Commercial	$21.49
Rate for Payer: Aetna Medicare Advantage	$21.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.26
Rate for Payer: Cigna Commercial	$1.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.74

CYCLOSPORINE 100 MG CAP

Facility

$71.62

Service Code	HCPCS J7502
Hospital Charge Code	6001531
Hospital Revenue Code	636
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$17.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.74

CYCLOSPORINE100MG/ML ORAL 50ML

Facility

$87.03

Service Code	HCPCS J7502
Hospital Charge Code	6001523
Hospital Revenue Code	636
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$26.11
Rate for Payer: Aetna Commercial	$26.11
Rate for Payer: Aetna Medicare Advantage	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.19
Rate for Payer: Cigna Commercial	$1.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

Know your out-of-pocket cost for care.

All Charges