Heights University Hospital

All Charges

Charge

Type

Setting

Price

CARBAMIDE PEROXIDE 15 ML SOL

Facility

$16.62

Service Code	NDC 904322035
Hospital Charge Code	60628085
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.49

CARBAMIDE PEROX OTIC 6.5% 15ML

Facility

$34.60

Hospital Charge Code	6000897
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

CARBAMIDE PEROX OTIC 6.5% 15ML

Facility

$34.60

Hospital Charge Code	6000897
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

CARBENICIL OPH GTT 100MG/ML

Facility

$131.85

Hospital Charge Code	6000921
Hospital Revenue Code	251
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

CARBENICIL OPH GTT 100MG/ML

Facility

$131.85

Hospital Charge Code	6000921
Hospital Revenue Code	251
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$39.55
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.14
Rate for Payer: Oxford Commercial	$65.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$65.92

CARBENICIL OPH ITV 20MG/ML

Facility

$90.90

Hospital Charge Code	6000905
Hospital Revenue Code	251
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

CARBENICIL OPH ITV 20MG/ML

Facility

$90.90

Hospital Charge Code	6000905
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

CARBENICIL OPH SBCNJ 400MG/ML

Facility

$227.85

Hospital Charge Code	6000913
Hospital Revenue Code	251
Min. Negotiated Rate	$29.62
Max. Negotiated Rate	$113.92
Rate for Payer: Aetna Commercial	$68.36
Rate for Payer: Aetna Medicare Advantage	$68.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.10
Rate for Payer: Cigna Commercial	$113.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.62
Rate for Payer: Oxford Commercial	$113.92
Rate for Payer: Qualcare PPO/HMO/WC	$34.18
Rate for Payer: UnitedHealthcare Commercial	$113.92

CARBENICIL OPH SBCNJ 400MG/ML

Facility

$227.85

Hospital Charge Code	6000913
Hospital Revenue Code	251
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$34.18
Rate for Payer: Qualcare PPO/HMO/WC	$34.18

CARBETAP/CHLRPHEN/PHNYLE 60 ML

Facility

$929.65

Hospital Charge Code	60628961
Hospital Revenue Code	250
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$139.45
Rate for Payer: Qualcare PPO/HMO/WC	$139.45

CARBETAP/CHLRPHEN/PHNYLE 60 ML

Facility

$929.65

Hospital Charge Code	60628961
Hospital Revenue Code	250
Min. Negotiated Rate	$120.85
Max. Negotiated Rate	$464.82
Rate for Payer: Aetna Commercial	$278.89
Rate for Payer: Aetna Medicare Advantage	$278.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.06
Rate for Payer: Cigna Commercial	$464.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.85
Rate for Payer: Oxford Commercial	$464.82
Rate for Payer: Qualcare PPO/HMO/WC	$139.45
Rate for Payer: UnitedHealthcare Commercial	$464.82

CARBIDE CUTTER BUR AM-52

Facility

$357.00

Hospital Charge Code	270335565
Hospital Revenue Code	272
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.41
Rate for Payer: Oxford Commercial	$178.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Commercial	$178.50

CARBIDE CUTTER BUR AM-52

Facility

$357.00

Hospital Charge Code	270335565
Hospital Revenue Code	272
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

CARBIDE DRILL 3MM

Facility

$1,075.00

Hospital Charge Code	270690527
Hospital Revenue Code	272
Min. Negotiated Rate	$139.75
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Oxford Commercial	$537.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Commercial	$537.50

CARBIDE DRILL 3MM

Facility

$1,075.00

Hospital Charge Code	270690527
Hospital Revenue Code	272
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$161.25
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CARBIDOPA 25/LEVOD 100MG SATAB

Facility

$7.20

Hospital Charge Code	606350914
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

CARBIDOPA 25/LEVOD 100MG SATAB

Facility

$7.20

Hospital Charge Code	606350914
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna Commercial	$2.16
Rate for Payer: Aetna Medicare Advantage	$2.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.84
Rate for Payer: Cigna Commercial	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$3.60

CARBIDOPA/LEVODOPA 48.7-195MG

Facility

$54.35

Hospital Charge Code	606390046
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$8.15
Rate for Payer: Qualcare PPO/HMO/WC	$8.15

CARBIDOPA/LEVODOPA 48.7-195MG

Facility

$54.35

Hospital Charge Code	606390046
Hospital Revenue Code	250
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$27.18
Rate for Payer: Aetna Commercial	$16.30
Rate for Payer: Aetna Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.86
Rate for Payer: Cigna Commercial	$27.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.07
Rate for Payer: Oxford Commercial	$27.18
Rate for Payer: Qualcare PPO/HMO/WC	$8.15
Rate for Payer: UnitedHealthcare Commercial	$27.18

CARBIDOPA LEVODPA SRTA25-100MG

Facility

$5.80

Hospital Charge Code	60627866
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CARBIDOPA LEVODPA SRTA25-100MG

Facility

$5.80

Hospital Charge Code	60627866
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

CARBIDOPA LEVODPA STRA50-200MG

Facility

$18.89

Service Code	NDC 6391968
Hospital Charge Code	60627869
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.83

CARBIDOPA LEVODPA STRA50-200MG

Facility

$18.89

Service Code	NDC 6391968
Hospital Charge Code	60627869
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$9.45
Rate for Payer: Aetna Commercial	$5.67
Rate for Payer: Aetna Medicare Advantage	$5.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.82
Rate for Payer: Cigna Commercial	$9.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.46
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.83
Rate for Payer: UnitedHealthcare Commercial	$9.45

CARBIDOPA LEVODPA TAB 10-100MG

Facility

$8.11

Service Code	NDC 904771861
Hospital Charge Code	60627865
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.22

CARBIDOPA LEVODPA TAB 10-100MG

Facility

$8.11

Service Code	NDC 904771861
Hospital Charge Code	60627865
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.05
Rate for Payer: Aetna Commercial	$2.43
Rate for Payer: Aetna Medicare Advantage	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.07
Rate for Payer: Cigna Commercial	$4.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.05
Rate for Payer: Oxford Commercial	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.22
Rate for Payer: UnitedHealthcare Commercial	$4.05

Know your out-of-pocket cost for care.

All Charges