Heights University Hospital

All Charges

Charge

Type

Setting

Price

CIPRO/200MG/VIAL

Facility

$61.00

Hospital Charge Code	60634500
Hospital Revenue Code	636
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

CIPRO/200MG/VIAL

Facility

$61.00

Hospital Charge Code	60634500
Hospital Revenue Code	636
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$14.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

CIPRO/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632700
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

CIPRO/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632704
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

CIPRO/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632704
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CIPRO/250MG/TAB

Facility

$13.00

Hospital Charge Code	60632700
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CIPRO/400MG/BAG

Facility

$196.00

Hospital Charge Code	60634501
Hospital Revenue Code	636
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$47.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

CIPRO/400MG/BAG

Facility

$196.00

Hospital Charge Code	60634501
Hospital Revenue Code	636
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$98.00
Rate for Payer: Aetna Commercial	$58.80
Rate for Payer: Aetna Medicare Advantage	$58.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.98
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

CIPRO 400MG VIAL INJ

Facility

$195.00

Hospital Charge Code	60635381
Hospital Revenue Code	636
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$47.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CIPRO 400MG VIAL INJ

Facility

$195.00

Hospital Charge Code	60635381
Hospital Revenue Code	636
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CIPRO/500MG/TAB

Facility

$18.00

Hospital Charge Code	60632701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

CIPRO/500MG/TAB

Facility

$13.00

Hospital Charge Code	60632705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

CIPRO/500MG/TAB

Facility

$18.00

Hospital Charge Code	60632701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

CIPRO/500MG/TAB

Facility

$13.00

Hospital Charge Code	60632705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CIPRO/750MG/TAB

Facility

$32.00

Hospital Charge Code	60632702
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
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	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

CIPRO/750MG/TAB

Facility

$28.00

Hospital Charge Code	60632703
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

CIPRO/750MG/TAB

Facility

$28.00

Hospital Charge Code	60632703
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

CIPRO/750MG/TAB

Facility

$32.00

Hospital Charge Code	60632702
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CIPRO-DEXAMETHASONE OTIC

Facility

$1,343.89

Service Code	NDC 78079975
Hospital Charge Code	60629949
Hospital Revenue Code	250
Min. Negotiated Rate	$174.71
Max. Negotiated Rate	$671.95
Rate for Payer: Aetna Commercial	$403.17
Rate for Payer: Aetna Medicare Advantage	$403.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.69
Rate for Payer: Cigna Commercial	$671.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.71
Rate for Payer: Oxford Commercial	$671.95
Rate for Payer: Qualcare PPO/HMO/WC	$201.58
Rate for Payer: UnitedHealthcare Commercial	$671.95

CIPRO-DEXAMETHASONE OTIC

Facility

$1,343.89

Service Code	NDC 78079975
Hospital Charge Code	60629949
Hospital Revenue Code	250
Min. Negotiated Rate	$201.58
Max. Negotiated Rate	$201.58
Rate for Payer: Qualcare PPO/HMO/WC	$201.58

CIPROFLOXACIN 0.3% OPHTH SOLN

Facility

$166.83

Service Code	NDC 50383028202
Hospital Charge Code	60628033
Hospital Revenue Code	250
Min. Negotiated Rate	$25.02
Max. Negotiated Rate	$25.02
Rate for Payer: Qualcare PPO/HMO/WC	$25.02

CIPROFLOXACIN 0.3% OPHTH SOLN

Facility

$166.83

Service Code	NDC 50383028202
Hospital Charge Code	60628033
Hospital Revenue Code	250
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$83.42
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$50.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.54
Rate for Payer: Cigna Commercial	$83.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.69
Rate for Payer: Oxford Commercial	$83.42
Rate for Payer: Qualcare PPO/HMO/WC	$25.02
Rate for Payer: UnitedHealthcare Commercial	$83.42

CIPROFLOXACIN 0.3% OP SOL/DROP

Facility

$2.88

Hospital Charge Code	606361100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna Commercial	$0.86
Rate for Payer: Aetna Medicare Advantage	$0.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.73
Rate for Payer: Cigna Commercial	$1.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.37
Rate for Payer: Oxford Commercial	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.43
Rate for Payer: UnitedHealthcare Commercial	$1.44

CIPROFLOXACIN 0.3% OP SOL/DROP

Facility

$2.88

Hospital Charge Code	606361100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.43

CIPROFLOXACIN 200MG/100ML

Facility

$104.59

Service Code	HCPCS J0744
Hospital Charge Code	60627346
Hospital Revenue Code	636
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$25.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.69

Know your out-of-pocket cost for care.

All Charges