Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

CYCLOSPORINE 250 MG/5ML INJ

Facility

$314.43

Service Code	HCPCS J7516
Hospital Charge Code	60628523
Hospital Revenue Code	636
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$76.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.09
Rate for Payer: Qualcare PPO/HMO/WC	$47.16

CYCLOSPORINE 250 MG/5ML INJ

Facility

$314.43

Service Code	HCPCS J7516
Hospital Charge Code	60628523
Hospital Revenue Code	636
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$94.33
Rate for Payer: Aetna Commercial	$94.33
Rate for Payer: Aetna Medicare Advantage	$94.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.18
Rate for Payer: Cigna Commercial	$74.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.09
Rate for Payer: Qualcare PPO/HMO/WC	$47.16

CYCLOSPORINE 25 MG CAP

Facility

$22.45

Service Code	HCPCS J7515
Hospital Charge Code	60628599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$0.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

CYCLOSPORINE 25 MG CAP

Facility

$22.45

Service Code	HCPCS J7515
Hospital Charge Code	60628599
Hospital Revenue Code	636
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$5.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

CYCLOSPORINE 25 MG TAB

Facility

$7.00

Hospital Charge Code	60635070
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CYCLOSPORINE 25 MG TAB

Facility

$7.00

Hospital Charge Code	60635070
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CYCLOSPORINE A TROUGH

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3035151
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.14
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.13
Rate for Payer: Wellcare Medicare Advantage	$18.05

CYCLOSPORINE A TROUGH

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3035151
Hospital Revenue Code	301
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00

CYCLOSPORINE,BLOOD

Facility

$566.00

Service Code	HCPCS 80158
Hospital Charge Code	38473095
Hospital Revenue Code	301
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

CYCLOSPORINE,BLOOD

Facility

$566.00

Service Code	HCPCS 80158
Hospital Charge Code	38473095
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.14
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.13
Rate for Payer: Wellcare Medicare Advantage	$18.05

CYCLOSPORINE CAP 250MG

Facility

$10.25

Hospital Charge Code	60628524
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.61
Rate for Payer: Cigna Commercial	$5.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.12

CYCLOSPORINE CAP 250MG

Facility

$10.25

Hospital Charge Code	60628524
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

CYCLOSPORINE CAP 25MG

Facility

$9.00

Hospital Charge Code	60628838
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CYCLOSPORINE CAP 25MG

Facility

$9.00

Hospital Charge Code	60628838
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CYCLOSPORINE INJ 250MG/5ML

Facility

$192.65

Hospital Charge Code	6001549
Hospital Revenue Code	250
Min. Negotiated Rate	$25.04
Max. Negotiated Rate	$96.33
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna Medicare Advantage	$57.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.13
Rate for Payer: Cigna Commercial	$96.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.04
Rate for Payer: Oxford Commercial	$96.33
Rate for Payer: Qualcare PPO/HMO/WC	$28.90
Rate for Payer: UnitedHealthcare Commercial	$96.33

CYCLOSPORINE INJ 250MG/5ML

Facility

$192.65

Hospital Charge Code	6001549
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$28.90
Rate for Payer: Qualcare PPO/HMO/WC	$28.90

CYCLOSPORINE,LCMSMS,BLOOD

Facility

$390.00

Service Code	HCPCS 80158
Hospital Charge Code	39900004
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.14
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
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	$18.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.13
Rate for Payer: Wellcare Medicare Advantage	$18.05

CYCLOSPORINE,LCMSMS,BLOOD

Facility

$390.00

Service Code	HCPCS 80158
Hospital Charge Code	39900004
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYCLOSPORINE,NONSPECIFIC

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3031359
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.14
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.13
Rate for Payer: Wellcare Medicare Advantage	$18.05

CYCLOSPORINE,NONSPECIFIC

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3031359
Hospital Revenue Code	301
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00

CYCLOSPORINE SOL OPH 2%

Facility

$685.45

Hospital Charge Code	6001556
Hospital Revenue Code	252
Min. Negotiated Rate	$102.82
Max. Negotiated Rate	$102.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.82

CYCLOSPORINE SOL OPH 2%

Facility

$685.45

Hospital Charge Code	6001556
Hospital Revenue Code	252
Min. Negotiated Rate	$89.11
Max. Negotiated Rate	$342.73
Rate for Payer: Aetna Commercial	$205.63
Rate for Payer: Aetna Medicare Advantage	$205.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.79
Rate for Payer: Cigna Commercial	$342.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.11
Rate for Payer: Oxford Commercial	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$102.82
Rate for Payer: UnitedHealthcare Commercial	$342.73

CYCLOSPORINE (SPECIFIC BLOOD)

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3031358
Hospital Revenue Code	301
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00

CYCLOSPORINE (SPECIFIC BLOOD)

Facility

$246.65

Service Code	HCPCS 80158
Hospital Charge Code	3031358
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.14
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.13
Rate for Payer: Wellcare Medicare Advantage	$18.05

Know your out-of-pocket cost for care.

All Charges