Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

CIPROFLOXACIN 250 MG TAB

Facility

$30.42

Service Code	NDC 16252051401
Hospital Charge Code	6008619
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

CIPROFLOXACIN 250 MG TAB

Facility

$30.42

Service Code	NDC 16252051401
Hospital Charge Code	6008619
Hospital Revenue Code	250
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$9.13
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.95
Rate for Payer: Oxford Commercial	$15.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$15.21

CIPROFLOXACIN 400MG/200ML

Facility

$201.07

Service Code	HCPCS J0744
Hospital Charge Code	60627347
Hospital Revenue Code	636
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$60.32
Rate for Payer: Aetna Commercial	$60.32
Rate for Payer: Aetna Medicare Advantage	$60.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.27
Rate for Payer: Cigna Commercial	$0.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.66
Rate for Payer: Qualcare PPO/HMO/WC	$30.16

CIPROFLOXACIN 400MG/200ML

Facility

$201.07

Service Code	HCPCS J0744
Hospital Charge Code	60627347
Hospital Revenue Code	636
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$48.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.66
Rate for Payer: Qualcare PPO/HMO/WC	$30.16

CIPROFLOXACIN 500 MG TAB

Facility

$35.58

Service Code	NDC 16252051501
Hospital Charge Code	6008635
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

CIPROFLOXACIN 500 MG TAB

Facility

$35.58

Service Code	NDC 16252051501
Hospital Charge Code	6008635
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$17.79
Rate for Payer: Aetna Commercial	$10.67
Rate for Payer: Aetna Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.07
Rate for Payer: Cigna Commercial	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$17.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$17.79

CIPROFLOXACIN 750 MG TAB

Facility

$60.00

Hospital Charge Code	60627348
Hospital Revenue Code	252
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

CIPROFLOXACIN 750 MG TAB

Facility

$60.00

Hospital Charge Code	60627348
Hospital Revenue Code	252
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$30.00

CIPROFLOXACIN INJ 200MG

Facility

$70.40

Hospital Charge Code	6016364
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

CIPROFLOXACIN INJ 200MG

Facility

$70.40

Hospital Charge Code	6016364
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

CIPROFLOXACIN INJ 400MG

Facility

$136.35

Hospital Charge Code	6016372
Hospital Revenue Code	250
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

CIPROFLOXACIN INJ 400MG

Facility

$136.35

Hospital Charge Code	6016372
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$40.91
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.73
Rate for Payer: Oxford Commercial	$68.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$68.17

CIPROFLOXACIN OPH DROPS 5ML

Facility

$204.80

Hospital Charge Code	6008569
Hospital Revenue Code	252
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$102.40
Rate for Payer: Aetna Commercial	$61.44
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$102.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$102.40

CIPROFLOXACIN OPH DROPS 5ML

Facility

$204.80

Hospital Charge Code	6008569
Hospital Revenue Code	252
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

CIPROFLOXACIN TAB 750MG

Facility

$43.55

Hospital Charge Code	6010623
Hospital Revenue Code	252
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$13.06
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$21.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.77

CIPROFLOXACIN TAB 750MG

Facility

$43.55

Hospital Charge Code	6010623
Hospital Revenue Code	252
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

CIPRO IV 400MG/VIAL 40ML

Facility

$66.00

Hospital Charge Code	60635344
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CIPRO IV 400MG/VIAL 40ML

Facility

$66.00

Hospital Charge Code	60635344
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

CIRC ANES LAT FRE 188590LG40

Facility

$17.25

Hospital Charge Code	270625309
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

CIRC ANES LAT FRE 188590LG40

Facility

$17.25

Hospital Charge Code	270625309
Hospital Revenue Code	272
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$5.17
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.40
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.24
Rate for Payer: Oxford Commercial	$8.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$8.62

CIRCUIT ADULT PORT VENT

Facility

$17.62

Hospital Charge Code	270651843
Hospital Revenue Code	272
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.64

CIRCUIT ADULT PORT VENT

Facility

$17.62

Hospital Charge Code	270651843
Hospital Revenue Code	272
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$5.29
Rate for Payer: Aetna Medicare Advantage	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.49
Rate for Payer: Cigna Commercial	$8.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$8.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.64
Rate for Payer: UnitedHealthcare Commercial	$8.81

CIRCUIT ANESTHESIA 2253710-804

Facility

$16.85

Hospital Charge Code	270070041
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

CIRCUIT ANESTHESIA 2253710-804

Facility

$16.85

Hospital Charge Code	270070041
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$5.05
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.43

Know your out-of-pocket cost for care.

All Charges