Heights University Hospital

All Charges

Charge

Type

Setting

Price

TETANUS TOXOID FLUID/0.5M

Facility

$18.00

Hospital Charge Code	60633994
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

TETRACAINE 0.5% OPHTH/1ML

Facility

$18.00

Hospital Charge Code	60633996
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

TETRACAINE 0.5% OPHTH/1ML

Facility

$18.00

Hospital Charge Code	60633996
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TETRACAINE 0.5% OPHTH/2ML

Facility

$23.00

Hospital Charge Code	60633997
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

TETRACAINE 0.5% OPHTH/2ML

Facility

$23.00

Hospital Charge Code	60633997
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

TETRACAINE 0.5% O.S. 2ML

Facility

$61.45

Hospital Charge Code	6013262
Hospital Revenue Code	251
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

TETRACAINE 0.5% O.S. 2ML

Facility

$61.45

Hospital Charge Code	6013262
Hospital Revenue Code	251
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

TETRACAINE 1% 2ML

Facility

$610.57

Service Code	NDC 17478004532
Hospital Charge Code	6063943310
Hospital Revenue Code	250
Min. Negotiated Rate	$79.37
Max. Negotiated Rate	$305.29
Rate for Payer: Aetna Commercial	$183.17
Rate for Payer: Aetna Medicare Advantage	$183.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.70
Rate for Payer: Cigna Commercial	$305.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.37
Rate for Payer: Oxford Commercial	$305.29
Rate for Payer: Qualcare PPO/HMO/WC	$91.59
Rate for Payer: UnitedHealthcare Commercial	$305.29

TETRACAINE 1% 2ML

Facility

$610.57

Service Code	NDC 17478004532
Hospital Charge Code	6063943310
Hospital Revenue Code	250
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$91.59
Rate for Payer: Qualcare PPO/HMO/WC	$91.59

TETRACAINE/ADRENALIN/COCAINE

Facility

$420.00

Hospital Charge Code	6062320
Hospital Revenue Code	250
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

TETRACAINE/ADRENALIN/COCAINE

Facility

$336.00

Hospital Charge Code	60628561
Hospital Revenue Code	250
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

TETRACAINE/ADRENALIN/COCAINE

Facility

$420.00

Hospital Charge Code	6062320
Hospital Revenue Code	250
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$210.00

TETRACAINE/ADRENALIN/COCAINE

Facility

$336.00

Hospital Charge Code	60628561
Hospital Revenue Code	250
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$100.80
Rate for Payer: Aetna Medicare Advantage	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.68
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.68
Rate for Payer: Oxford Commercial	$168.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$168.00

TETRACAINE INJ 1% 2ML

Facility

$37.80

Hospital Charge Code	6005201
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

TETRACAINE INJ 1% 2ML

Facility

$37.80

Hospital Charge Code	6005201
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

TETRACAINE OPH OINT .5% 3.5GM

Facility

$90.90

Hospital Charge Code	6005227
Hospital Revenue Code	251
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

TETRACAINE OPH OINT .5% 3.5GM

Facility

$90.90

Hospital Charge Code	6005227
Hospital Revenue Code	251
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$27.27
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.82
Rate for Payer: Oxford Commercial	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$45.45

TETRACAINE OPH SOL .5% 1ML

Facility

$67.00

Service Code	NDC 65074112
Hospital Charge Code	6005235
Hospital Revenue Code	251
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

TETRACAINE OPH SOL .5% 1ML

Facility

$67.00

Service Code	NDC 65074112
Hospital Charge Code	6005235
Hospital Revenue Code	251
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$20.10
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$33.50

TETRACAINE OPHT 0.5% 15ML

Facility

$42.16

Hospital Charge Code	60635809
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

TETRACAINE OPHT 0.5% 15ML

Facility

$42.16

Hospital Charge Code	60635809
Hospital Revenue Code	250
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$21.08
Rate for Payer: Aetna Commercial	$12.65
Rate for Payer: Aetna Medicare Advantage	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.75
Rate for Payer: Cigna Commercial	$21.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.48
Rate for Payer: Oxford Commercial	$21.08
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$21.08

TETRACAINE SOL 2% 118ML

Facility

$670.45

Hospital Charge Code	60628424
Hospital Revenue Code	250
Min. Negotiated Rate	$87.16
Max. Negotiated Rate	$335.23
Rate for Payer: Aetna Commercial	$201.13
Rate for Payer: Aetna Medicare Advantage	$201.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.96
Rate for Payer: Cigna Commercial	$335.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.16
Rate for Payer: Oxford Commercial	$335.23
Rate for Payer: Qualcare PPO/HMO/WC	$100.57
Rate for Payer: UnitedHealthcare Commercial	$335.23

TETRACAINE SOL 2% 118ML

Facility

$670.45

Hospital Charge Code	60628424
Hospital Revenue Code	250
Min. Negotiated Rate	$100.57
Max. Negotiated Rate	$100.57
Rate for Payer: Qualcare PPO/HMO/WC	$100.57

TETRACAINE TOP 2% 30ML

Facility

$7.25

Hospital Charge Code	6005219
Hospital Revenue Code	251
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

TETRACAINE TOP 2% 30ML

Facility

$7.25

Hospital Charge Code	6005219
Hospital Revenue Code	251
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

Know your out-of-pocket cost for care.

All Charges