Heights University Hospital

All Charges

Charge

Type

Setting

Price

CARBACHOL 0PHT .01% 1.5ML

Facility

$229.80

Hospital Charge Code	6000889
Hospital Revenue Code	251
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$34.47
Rate for Payer: Qualcare PPO/HMO/WC	$34.47

CARBACHOL 0PHT .01% 1.5ML

Facility

$229.80

Hospital Charge Code	6000889
Hospital Revenue Code	251
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$114.90
Rate for Payer: Aetna Commercial	$68.94
Rate for Payer: Aetna Medicare Advantage	$68.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.60
Rate for Payer: Cigna Commercial	$114.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.87
Rate for Payer: Oxford Commercial	$114.90
Rate for Payer: Qualcare PPO/HMO/WC	$34.47
Rate for Payer: UnitedHealthcare Commercial	$114.90

CARBACHOL 1.5% OPHTH SOLN

Facility

$242.10

Hospital Charge Code	60628054
Hospital Revenue Code	250
Min. Negotiated Rate	$31.47
Max. Negotiated Rate	$121.05
Rate for Payer: Aetna Commercial	$72.63
Rate for Payer: Aetna Medicare Advantage	$72.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.74
Rate for Payer: Cigna Commercial	$121.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.47
Rate for Payer: Oxford Commercial	$121.05
Rate for Payer: Qualcare PPO/HMO/WC	$36.31
Rate for Payer: UnitedHealthcare Commercial	$121.05

CARBACHOL 1.5% OPHTH SOLN

Facility

$242.10

Hospital Charge Code	60628054
Hospital Revenue Code	250
Min. Negotiated Rate	$36.31
Max. Negotiated Rate	$36.31
Rate for Payer: Qualcare PPO/HMO/WC	$36.31

CARBACHOL 3% OPHTH SOLN

Facility

$12.85

Hospital Charge Code	6000871
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

CARBACHOL 3% OPHTH SOLN

Facility

$12.85

Hospital Charge Code	6000871
Hospital Revenue Code	251
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$6.42

CARBACHOL OPHT 1.5% 15ML

Facility

$125.45

Hospital Charge Code	6000863
Hospital Revenue Code	251
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

CARBACHOL OPHT 1.5% 15ML

Facility

$125.45

Hospital Charge Code	6000863
Hospital Revenue Code	251
Min. Negotiated Rate	$16.31
Max. Negotiated Rate	$62.73
Rate for Payer: Aetna Commercial	$37.63
Rate for Payer: Aetna Medicare Advantage	$37.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.99
Rate for Payer: Cigna Commercial	$62.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.31
Rate for Payer: Oxford Commercial	$62.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$62.73

CARBAMAZEPINE 100 MG/5 ML SUSP

Facility

$6.57

Service Code	NDC 51672404704
Hospital Charge Code	60628753
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$1.97
Rate for Payer: Aetna Medicare Advantage	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.68
Rate for Payer: Cigna Commercial	$3.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.85
Rate for Payer: Oxford Commercial	$3.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$3.29

CARBAMAZEPINE 100 MG/5 ML SUSP

Facility

$6.57

Service Code	NDC 51672404704
Hospital Charge Code	60628753
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

CARBAMAZEPINE 100 MG CHEW TAB

Facility

$4.42

Service Code	NDC 51672404101
Hospital Charge Code	60627746
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.57
Rate for Payer: Oxford Commercial	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$2.21

CARBAMAZEPINE 100 MG CHEW TAB

Facility

$4.42

Service Code	NDC 51672404101
Hospital Charge Code	60627746
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

CARBAMAZEPINE 200 MG TAB

Facility

$13.94

Service Code	NDC 78050905
Hospital Charge Code	6023162
Hospital Revenue Code	251
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

CARBAMAZEPINE 200 MG TAB

Facility

$13.94

Service Code	NDC 78050905
Hospital Charge Code	6023162
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$6.97
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.55
Rate for Payer: Cigna Commercial	$6.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.09
Rate for Payer: UnitedHealthcare Commercial	$6.97

CARBAMAZEPINE FREE,LC/MS/MS

Facility

$90.30

Service Code	HCPCS 80157
Hospital Charge Code	3970738
Hospital Revenue Code	306
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.55
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.54
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.04
Rate for Payer: Wellcare Medicare Advantage	$13.25

CARBAMAZEPINE FREE,LC/MS/MS

Facility

$90.30

Service Code	HCPCS 80157
Hospital Charge Code	3970738
Hospital Revenue Code	306
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$13.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.54

CARBAMAZEPINE (TEGRETOL)

Facility

$339.00

Service Code	HCPCS 80156
Hospital Charge Code	38472158
Hospital Revenue Code	301
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.21
Rate for Payer: Aetna Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
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	$53.38
Rate for Payer: Cigna Commercial	$14.57
Rate for Payer: Cigna Medicare Advantage	$7.29
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.44
Rate for Payer: Wellcare Medicare Advantage	$14.57

CARBAMAZEPINE (TEGRETOL)

Facility

$339.00

Service Code	HCPCS 80156
Hospital Charge Code	38472158
Hospital Revenue Code	301
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

CARBAMAZEPINE TEGRETOL

Facility

$390.00

Service Code	HCPCS 80156
Hospital Charge Code	3006376
Hospital Revenue Code	301
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.21
Rate for Payer: Aetna Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
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	$53.38
Rate for Payer: Cigna Commercial	$14.57
Rate for Payer: Cigna Medicare Advantage	$7.29
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
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	$14.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.44
Rate for Payer: Wellcare Medicare Advantage	$14.57

CARBAMAZEPINE TEGRETOL

Facility

$390.00

Service Code	HCPCS 80156
Hospital Charge Code	3006376
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARBAMAZIPINE 100MG/5ML 450ML

Facility

$204.80

Hospital Charge Code	6009294
Hospital Revenue Code	251
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

CARBAMAZIPINE 100MG/5ML 450ML

Facility

$204.80

Hospital Charge Code	6009294
Hospital Revenue Code	251
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

CARBAMEZAPINE TAB 200MG

Facility

$1.95

Hospital Charge Code	6023253
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CARBAMEZAPINE TAB 200MG

Facility

$1.95

Hospital Charge Code	6023253
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

CARBAMIDE PEROXIDE 15 ML SOL

Facility

$16.62

Service Code	NDC 904322035
Hospital Charge Code	60628085
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$8.31
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare Advantage	$4.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.24
Rate for Payer: Cigna Commercial	$8.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$8.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.49
Rate for Payer: UnitedHealthcare Commercial	$8.31

Know your out-of-pocket cost for care.

All Charges