Heights University Hospital

All Charges

Charge

Type

Setting

Price

CARBIDOPA LEVODPA TAB 25-100MG

Facility

$8.78

Service Code	NDC 51079097820
Hospital Charge Code	60627867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

CARBIDOPA LEVODPA TAB 25-100MG

Facility

$8.78

Service Code	NDC 51079097820
Hospital Charge Code	60627867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$4.39
Rate for Payer: Aetna Commercial	$2.63
Rate for Payer: Aetna Medicare Advantage	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.24
Rate for Payer: Cigna Commercial	$4.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.14
Rate for Payer: Oxford Commercial	$4.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Commercial	$4.39

CARBIDOPA LEVODPA TAB 25-250MG

Facility

$6.37

Service Code	NDC 68084009401
Hospital Charge Code	60627868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

CARBIDOPA LEVODPA TAB 25-250MG

Facility

$6.37

Service Code	NDC 68084009401
Hospital Charge Code	60627868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$1.91
Rate for Payer: Aetna Medicare Advantage	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.62
Rate for Payer: Cigna Commercial	$3.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.83
Rate for Payer: Oxford Commercial	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$3.19

CARBINOXAMINE DM PSEUDOEPH DRP

Facility

$179.50

Hospital Charge Code	60627220
Hospital Revenue Code	251
Min. Negotiated Rate	$26.93
Max. Negotiated Rate	$26.93
Rate for Payer: Qualcare PPO/HMO/WC	$26.93

CARBINOXAMINE DM PSEUDOEPH DRP

Facility

$179.50

Hospital Charge Code	60627220
Hospital Revenue Code	251
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$89.75
Rate for Payer: Aetna Commercial	$53.85
Rate for Payer: Aetna Medicare Advantage	$53.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.77
Rate for Payer: Cigna Commercial	$89.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.34
Rate for Payer: Oxford Commercial	$89.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.93
Rate for Payer: UnitedHealthcare Commercial	$89.75

CARBINOXAMINE DM PSEUDOEPH LIQ

Facility

$17.95

Hospital Charge Code	60627219
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

CARBINOXAMINE DM PSEUDOEPH LIQ

Facility

$17.95

Hospital Charge Code	60627219
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

CARBINOXAMINE PSEUDOEPH SRP

Facility

$5.65

Hospital Charge Code	60627218
Hospital Revenue Code	251
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

CARBINOXAMINE PSEUDOEPH SRP

Facility

$5.65

Hospital Charge Code	60627218
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

CARBOCAINE 1%/50ML

Facility

$56.00

Hospital Charge Code	60632620
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$28.00

CARBOCAINE 1%/50ML

Facility

$56.00

Hospital Charge Code	60632620
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

CARBOCAINE INJ 2%/50ML/VI

Facility

$41.74

Service Code	NDC 409106720
Hospital Charge Code	60634424
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$20.87
Rate for Payer: Aetna Commercial	$12.52
Rate for Payer: Aetna Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.64
Rate for Payer: Cigna Commercial	$20.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.43
Rate for Payer: Oxford Commercial	$20.87
Rate for Payer: Qualcare PPO/HMO/WC	$6.26
Rate for Payer: UnitedHealthcare Commercial	$20.87

CARBOCAINE INJ 2%/50ML/VI

Facility

$41.74

Service Code	NDC 409106720
Hospital Charge Code	60634424
Hospital Revenue Code	250
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$6.26
Rate for Payer: Qualcare PPO/HMO/WC	$6.26

Carbohydrate Antigen (CA) 19-9

Facility

$667.59

Service Code	HCPCS 86301
Hospital Charge Code	39888023
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Carbohydrate Antigen (CA) 19-9

Facility

$667.59

Service Code	HCPCS 86301
Hospital Charge Code	39888023
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.42
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$20.81
Rate for Payer: Cigna Medicare Advantage	$10.40
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.06
Rate for Payer: Wellcare Medicare Advantage	$20.81

CARBON DIOXIDE***

Facility

$22.00

Hospital Charge Code	3010618
Hospital Revenue Code	309
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

CARBON DIOXIDE***

Facility

$22.00

Hospital Charge Code	3010618
Hospital Revenue Code	309
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

CARBON DIOXIDE, C02

Facility

$390.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARBON DIOXIDE, C02

Facility

$390.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619
Hospital Revenue Code	301
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.88
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: Cigna Medicare Advantage	$2.44
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
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	$4.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.17
Rate for Payer: Wellcare Medicare Advantage	$4.88

CARBON DIOXIDE (CO 2)

Facility

$83.00

Service Code	HCPCS 82374
Hospital Charge Code	38472161
Hospital Revenue Code	301
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.88
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: Cigna Medicare Advantage	$2.44
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.17
Rate for Payer: Wellcare Medicare Advantage	$4.88

CARBON DIOXIDE (CO 2)

Facility

$83.00

Service Code	HCPCS 82374
Hospital Charge Code	38472161
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

CARBON DIOXIDE CO2 PANEL***

Facility

$6.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CARBON DIOXIDE CO2 PANEL***

Facility

$6.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.88
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: Cigna Medicare Advantage	$2.44
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.17
Rate for Payer: Wellcare Medicare Advantage	$4.88

CARBON MONOXIDE

Facility

$291.25

Service Code	HCPCS 82375
Hospital Charge Code	3007275
Hospital Revenue Code	301
Min. Negotiated Rate	$43.69
Max. Negotiated Rate	$43.69
Rate for Payer: Qualcare PPO/HMO/WC	$43.69

Know your out-of-pocket cost for care.

All Charges