Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLOXIN/400MG/TAB

Facility

$13.00

Hospital Charge Code	60634322
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

FLOXIN/400MG/TAB

Facility

$13.00

Hospital Charge Code	60634322
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

FLOXURIDINE 500 MG INJ

Facility

$681.90

Hospital Charge Code	60627381
Hospital Revenue Code	636
Min. Negotiated Rate	$102.28
Max. Negotiated Rate	$165.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.02
Rate for Payer: Qualcare PPO/HMO/WC	$102.28

FLOXURIDINE 500 MG INJ

Facility

$681.90

Hospital Charge Code	60627381
Hospital Revenue Code	636
Min. Negotiated Rate	$102.28
Max. Negotiated Rate	$340.95
Rate for Payer: Aetna Commercial	$204.57
Rate for Payer: Aetna Medicare Advantage	$204.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.88
Rate for Payer: Cigna Commercial	$340.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.02
Rate for Payer: Qualcare PPO/HMO/WC	$102.28

FLOXURIDINE INJ VL 500MG

Facility

$993.95

Hospital Charge Code	6007660
Hospital Revenue Code	636
Min. Negotiated Rate	$149.09
Max. Negotiated Rate	$496.98
Rate for Payer: Aetna Commercial	$298.19
Rate for Payer: Aetna Medicare Advantage	$298.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.46
Rate for Payer: Cigna Commercial	$496.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.54
Rate for Payer: Qualcare PPO/HMO/WC	$149.09

FLOXURIDINE INJ VL 500MG

Facility

$993.95

Hospital Charge Code	6007660
Hospital Revenue Code	636
Min. Negotiated Rate	$149.09
Max. Negotiated Rate	$240.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.54
Rate for Payer: Qualcare PPO/HMO/WC	$149.09

FLUAD HIGH DOSE VACCINE

Facility

$46.79

Service Code	HCPCS 90694
Hospital Charge Code	412390694
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$23.39
Rate for Payer: Aetna Commercial	$14.04
Rate for Payer: Aetna Medicare Advantage	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.93
Rate for Payer: Cigna Commercial	$23.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

FLUAD HIGH DOSE VACCINE

Facility

$46.79

Service Code	HCPCS 90694
Hospital Charge Code	412390694
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

FLUAD TRI 0.5 ML 2024-25

Facility

$0.01

Service Code	HCPCS 90653
Hospital Charge Code	606390626
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUAD TRI 0.5 ML 2024-25

Facility

$0.01

Service Code	HCPCS 90653
Hospital Charge Code	606390626
Hospital Revenue Code	636
Max. Negotiated Rate	$98.16
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$98.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX 0.5ML 2024-25

Facility

$0.01

Service Code	HCPCS 90656
Hospital Charge Code	606390625
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX 0.5ML 2024-25

Facility

$0.01

Service Code	HCPCS 90656
Hospital Charge Code	606390625
Hospital Revenue Code	636
Max. Negotiated Rate	$23.22
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX PF 0.5ML>6MO 2023-2024

Facility

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	606390525
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX PF 0.5ML>6MO 2023-2024

Facility

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	606390525
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX QUAD PF .5ML 2022-23

Facility

$107.55

Service Code	HCPCS 90686
Hospital Charge Code	412390686B
Hospital Revenue Code	636
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$53.77
Rate for Payer: Aetna Commercial	$32.27
Rate for Payer: Aetna Medicare Advantage	$32.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.43
Rate for Payer: Cigna Commercial	$53.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.03
Rate for Payer: Qualcare PPO/HMO/WC	$16.13

FLUARIX QUAD PF .5ML 2022-23

Facility

$107.55

Service Code	HCPCS 90686
Hospital Charge Code	412390686B
Hospital Revenue Code	636
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$26.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.03
Rate for Payer: Qualcare PPO/HMO/WC	$16.13

FLUCELVAX PFSTRI 0.5MLSYR24-25

Facility

$0.01

Service Code	HCPCS 90661
Hospital Charge Code	606390627
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUCELVAX PFSTRI 0.5MLSYR24-25

Facility

$0.01

Service Code	HCPCS 90661
Hospital Charge Code	606390627
Hospital Revenue Code	636
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUCELVAX TRIVALENT 0.5ML

Facility

$132.79

Service Code	NDC 70461065404
Hospital Charge Code	6063943393
Hospital Revenue Code	250
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$19.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.92

FLUCELVAX TRIVALENT 0.5ML

Facility

$132.79

Service Code	NDC 70461065404
Hospital Charge Code	6063943393
Hospital Revenue Code	250
Min. Negotiated Rate	$17.26
Max. Negotiated Rate	$66.39
Rate for Payer: Aetna Commercial	$39.84
Rate for Payer: Aetna Medicare Advantage	$39.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.86
Rate for Payer: Cigna Commercial	$66.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.26
Rate for Payer: Oxford Commercial	$66.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.92
Rate for Payer: UnitedHealthcare Commercial	$66.39

FLUCONAZOLE 100 MG TAB

Facility

$58.49

Service Code	NDC 49342041
Hospital Charge Code	6008478
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$17.55
Rate for Payer: Aetna Medicare Advantage	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.91
Rate for Payer: Cigna Commercial	$29.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.60
Rate for Payer: Oxford Commercial	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$29.25

FLUCONAZOLE 100 MG TAB

Facility

$58.49

Service Code	NDC 49342041
Hospital Charge Code	6008478
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

FLUCONAZOLE 150MG TAB

Facility

$261.84

Service Code	NDC 49350079
Hospital Charge Code	6063943110
Hospital Revenue Code	250
Min. Negotiated Rate	$34.04
Max. Negotiated Rate	$130.92
Rate for Payer: Aetna Commercial	$78.55
Rate for Payer: Aetna Medicare Advantage	$78.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.77
Rate for Payer: Cigna Commercial	$130.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.04
Rate for Payer: Oxford Commercial	$130.92
Rate for Payer: Qualcare PPO/HMO/WC	$39.28
Rate for Payer: UnitedHealthcare Commercial	$130.92

FLUCONAZOLE 150MG TAB

Facility

$261.84

Service Code	NDC 49350079
Hospital Charge Code	6063943110
Hospital Revenue Code	250
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$39.28
Rate for Payer: Qualcare PPO/HMO/WC	$39.28

FLUCONAZOLE 200 MG TAB

Facility

$81.27

Service Code	NDC 49343030
Hospital Charge Code	6008486
Hospital Revenue Code	250
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$40.63
Rate for Payer: Aetna Commercial	$24.38
Rate for Payer: Aetna Medicare Advantage	$24.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$40.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.57
Rate for Payer: Oxford Commercial	$40.63
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$40.63

Know your out-of-pocket cost for care.

All Charges