Heights University Hospital

All Charges

Charge

Type

Setting

Price

CYCLOBENZAPRINE 5 MG TABLET

Facility

$4.95

Hospital Charge Code	60629309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.48
Rate for Payer: Aetna Commercial	$1.49
Rate for Payer: Aetna Medicare Advantage	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.26
Rate for Payer: Cigna Commercial	$2.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.64
Rate for Payer: Oxford Commercial	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.74
Rate for Payer: UnitedHealthcare Commercial	$2.48

CYCLOBENZAPRINE TAB 10MG

Facility

$3.20

Hospital Charge Code	6022388
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

CYCLOBENZAPRINE TAB 10MG

Facility

$3.20

Hospital Charge Code	6022388
Hospital Revenue Code	251
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

CYCLOGYL 1% OPHTH/5ML

Facility

$49.00

Hospital Charge Code	60632762
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

CYCLOGYL 1% OPHTH/5ML

Facility

$49.00

Hospital Charge Code	60632762
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

CYCLOGYL 2% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60632763
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

CYCLOGYL 2% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60632763
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

CYCLOPENTOLATE 1% OPHTH SOLN

Facility

$107.20

Service Code	NDC 65039602
Hospital Charge Code	6001457
Hospital Revenue Code	251
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$53.60
Rate for Payer: Aetna Commercial	$32.16
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$53.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.94
Rate for Payer: Oxford Commercial	$53.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.08
Rate for Payer: UnitedHealthcare Commercial	$53.60

CYCLOPENTOLATE 1% OPHTH SOLN

Facility

$107.20

Service Code	NDC 65039602
Hospital Charge Code	6001457
Hospital Revenue Code	251
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$16.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

CYCLOPENTOLATE 2% EYE DROPS

Facility

$197.72

Service Code	NDC 17478009702
Hospital Charge Code	60632359
Hospital Revenue Code	250
Min. Negotiated Rate	$29.66
Max. Negotiated Rate	$29.66
Rate for Payer: Qualcare PPO/HMO/WC	$29.66

CYCLOPENTOLATE 2% EYE DROPS

Facility

$197.72

Service Code	NDC 17478009702
Hospital Charge Code	60632359
Hospital Revenue Code	250
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$98.86
Rate for Payer: Aetna Commercial	$59.32
Rate for Payer: Aetna Medicare Advantage	$59.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.42
Rate for Payer: Cigna Commercial	$98.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.70
Rate for Payer: Oxford Commercial	$98.86
Rate for Payer: Qualcare PPO/HMO/WC	$29.66
Rate for Payer: UnitedHealthcare Commercial	$98.86

CYCLOPENTOLATE OPH 1% 5ML

Facility

$82.60

Hospital Charge Code	6001473
Hospital Revenue Code	251
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.74
Rate for Payer: Oxford Commercial	$41.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$41.30

CYCLOPENTOLATE OPH 1% 5ML

Facility

$82.60

Hospital Charge Code	6001473
Hospital Revenue Code	251
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

CYCLOPENTOLATE OPH 2% 2ML

Facility

$70.40

Hospital Charge Code	6001465
Hospital Revenue Code	251
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

CYCLOPENTOLATE OPH 2% 2ML

Facility

$70.40

Hospital Charge Code	6001465
Hospital Revenue Code	251
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

CYCLOPENTOLATE OPH 2% 5ML

Facility

$136.35

Hospital Charge Code	6001481
Hospital Revenue Code	251
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

CYCLOPENTOLATE OPH 2% 5ML

Facility

$136.35

Hospital Charge Code	6001481
Hospital Revenue Code	251
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

CYCLOPHASPHAMIDE 500MG

Facility

$89.00

Hospital Charge Code	6000061
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

CYCLOPHASPHAMIDE 500MG

Facility

$89.00

Hospital Charge Code	6000061
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

CYCLOPHOSPHAMDE LYOPH100M

Facility

$38.00

Hospital Charge Code	60632773
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

CYCLOPHOSPHAMDE LYOPH100M

Facility

$38.00

Hospital Charge Code	60632773
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

CYCLOPHOSPHAMIDE 100 MG TAB

Facility

$30.10

Hospital Charge Code	6001499
Hospital Revenue Code	259
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

CYCLOPHOSPHAMIDE 100 MG TAB

Facility

$30.10

Hospital Charge Code	6001499
Hospital Revenue Code	259
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

CYCLOPHOSPHAMIDE 200/MG

Facility

$80.00

Hospital Charge Code	60632774
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

CYCLOPHOSPHAMIDE 200/MG

Facility

$80.00

Hospital Charge Code	60632774
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

Know your out-of-pocket cost for care.

All Charges