Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 200 MG TAB

Facility

$81.27

Service Code	NDC 49343030
Hospital Charge Code	6008486
Hospital Revenue Code	250
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

FLUCONAZOLE 50 MG TAB

Facility

$104.72

Service Code	NDC 49341030
Hospital Charge Code	60627245
Hospital Revenue Code	250
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$15.71
Rate for Payer: Qualcare PPO/HMO/WC	$15.71

FLUCONAZOLE 50 MG TAB

Facility

$104.72

Service Code	NDC 49341030
Hospital Charge Code	60627245
Hospital Revenue Code	250
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$52.36
Rate for Payer: Aetna Commercial	$31.42
Rate for Payer: Aetna Medicare Advantage	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.70
Rate for Payer: Cigna Commercial	$52.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.61
Rate for Payer: Oxford Commercial	$52.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.71
Rate for Payer: UnitedHealthcare Commercial	$52.36

FLUCONAZOLE 50MG TABLET

Facility

$0.25

Hospital Charge Code	60635743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.04

FLUCONAZOLE 50MG TABLET

Facility

$0.25

Hospital Charge Code	60635743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna Commercial	$0.08
Rate for Payer: Aetna Medicare Advantage	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.06
Rate for Payer: Cigna Commercial	$0.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.03
Rate for Payer: Oxford Commercial	$0.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.04
Rate for Payer: UnitedHealthcare Commercial	$0.13

FLUCONAZOLE IV 200 MG/100ML NS

Facility

$137.62

Service Code	HCPCS J1450
Hospital Charge Code	6008494
Hospital Revenue Code	636
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$41.29
Rate for Payer: Aetna Commercial	$41.29
Rate for Payer: Aetna Medicare Advantage	$41.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$20.64

FLUCONAZOLE IV 200 MG/100ML NS

Facility

$137.62

Service Code	HCPCS J1450
Hospital Charge Code	6008494
Hospital Revenue Code	636
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$33.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$20.64

FLUCONAZOLE SSP 200MG/5ML 35ML

Facility

$681.00

Hospital Charge Code	60629101
Hospital Revenue Code	250
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$102.15
Rate for Payer: Qualcare PPO/HMO/WC	$102.15

FLUCONAZOLE SSP 200MG/5ML 35ML

Facility

$681.00

Hospital Charge Code	60629101
Hospital Revenue Code	250
Min. Negotiated Rate	$88.53
Max. Negotiated Rate	$340.50
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna Medicare Advantage	$204.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.66
Rate for Payer: Cigna Commercial	$340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.53
Rate for Payer: Oxford Commercial	$340.50
Rate for Payer: Qualcare PPO/HMO/WC	$102.15
Rate for Payer: UnitedHealthcare Commercial	$340.50

FLUCYTOSINE 250MG CAPSULE

Facility

$549.87

Service Code	NDC 64980017901
Hospital Charge Code	60631460
Hospital Revenue Code	250
Min. Negotiated Rate	$82.48
Max. Negotiated Rate	$82.48
Rate for Payer: Qualcare PPO/HMO/WC	$82.48

FLUCYTOSINE 250MG CAPSULE

Facility

$549.87

Service Code	NDC 64980017901
Hospital Charge Code	60631460
Hospital Revenue Code	250
Min. Negotiated Rate	$71.48
Max. Negotiated Rate	$274.94
Rate for Payer: Aetna Commercial	$164.96
Rate for Payer: Aetna Medicare Advantage	$164.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.22
Rate for Payer: Cigna Commercial	$274.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.48
Rate for Payer: Oxford Commercial	$274.94
Rate for Payer: Qualcare PPO/HMO/WC	$82.48
Rate for Payer: UnitedHealthcare Commercial	$274.94

FLUDARA/500MG/INJ

Facility

$845.00

Hospital Charge Code	60634724
Hospital Revenue Code	636
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

FLUDARA/500MG/INJ

Facility

$845.00

Hospital Charge Code	60634724
Hospital Revenue Code	636
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$253.50
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

FLUDARABINE 50 MG INJ

Facility

$2,459.03

Service Code	HCPCS J9185
Hospital Charge Code	60627382
Hospital Revenue Code	636
Min. Negotiated Rate	$368.85
Max. Negotiated Rate	$595.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.09
Rate for Payer: Qualcare PPO/HMO/WC	$368.85

FLUDARABINE 50 MG INJ

Facility

$2,459.03

Service Code	HCPCS J9185
Hospital Charge Code	60627382
Hospital Revenue Code	636
Min. Negotiated Rate	$217.73
Max. Negotiated Rate	$737.71
Rate for Payer: Aetna Commercial	$737.71
Rate for Payer: Aetna Medicare Advantage	$737.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$627.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$627.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$627.05
Rate for Payer: Cigna Commercial	$217.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.09
Rate for Payer: Qualcare PPO/HMO/WC	$368.85

FLUDARABINE INJ 50MG

Facility

$1,310.10

Hospital Charge Code	6006969
Hospital Revenue Code	636
Min. Negotiated Rate	$196.51
Max. Negotiated Rate	$317.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.04
Rate for Payer: Qualcare PPO/HMO/WC	$196.51

FLUDARABINE INJ 50MG

Facility

$1,310.10

Hospital Charge Code	6006969
Hospital Revenue Code	636
Min. Negotiated Rate	$196.51
Max. Negotiated Rate	$655.05
Rate for Payer: Aetna Commercial	$393.03
Rate for Payer: Aetna Medicare Advantage	$393.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.08
Rate for Payer: Cigna Commercial	$655.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.04
Rate for Payer: Qualcare PPO/HMO/WC	$196.51

FLUDROCORTISONE 0.1 MG TAB

Facility

$7.04

Service Code	NDC 68084028801
Hospital Charge Code	60628192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$1.06

FLUDROCORTISONE 0.1 MG TAB

Facility

$7.04

Service Code	NDC 68084028801
Hospital Charge Code	60628192
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$2.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.80
Rate for Payer: Cigna Commercial	$3.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.92
Rate for Payer: Oxford Commercial	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$1.06
Rate for Payer: UnitedHealthcare Commercial	$3.52

FLUENT DISPOSABLE PACK

Facility

$1,625.00

Hospital Charge Code	270693690
Hospital Revenue Code	272
Min. Negotiated Rate	$211.25
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$487.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.25
Rate for Payer: Oxford Commercial	$812.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$812.50

FLUENT DISPOSABLE PACK

Facility

$1,625.00

Hospital Charge Code	270693690
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

FLUID AMNIOTIC GRAFT 1.0CC

Facility

$6,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270695085
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FLUID AMNIOTIC GRAFT 1.0CC

Facility

$6,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270695085
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FLUID COLLECTION SYSTEM

Facility

$58.00

Hospital Charge Code	2008160
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

FLUID COLLECTION SYSTEM

Facility

$58.00

Hospital Charge Code	2008160
Hospital Revenue Code	272
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$17.40
Rate for Payer: Aetna Medicare Advantage	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.79
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.54
Rate for Payer: Oxford Commercial	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$29.00

Know your out-of-pocket cost for care.

All Charges