Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUID GF AMNIOT ALLOGRAFT 2CC

Facility

$12,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270694914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FLUID GF AMNIOT ALLOGRAFT 2CC

Facility

$12,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270694914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FLUID MANAGEMENT SYSTM MDD520H

Facility

$917.65

Hospital Charge Code	270627701
Hospital Revenue Code	272
Min. Negotiated Rate	$119.29
Max. Negotiated Rate	$458.82
Rate for Payer: Aetna Commercial	$275.30
Rate for Payer: Aetna Medicare Advantage	$275.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.00
Rate for Payer: Cigna Commercial	$458.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.29
Rate for Payer: Oxford Commercial	$458.82
Rate for Payer: Qualcare PPO/HMO/WC	$137.65
Rate for Payer: UnitedHealthcare Commercial	$458.82

FLUID MANAGEMENT SYSTM MDD520H

Facility

$917.65

Hospital Charge Code	270627701
Hospital Revenue Code	272
Min. Negotiated Rate	$137.65
Max. Negotiated Rate	$137.65
Rate for Payer: Qualcare PPO/HMO/WC	$137.65

FLUIDOTHERAPY CQ

Facility

$77.65

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022F
Hospital Revenue Code	420
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$686.00

FLUIDOTHERAPY CQ

Facility

$77.65

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022F
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

FLUID SET DUAL SPIKE

Facility

$1,321.65

Hospital Charge Code	270600359
Hospital Revenue Code	270
Min. Negotiated Rate	$198.25
Max. Negotiated Rate	$198.25
Rate for Payer: Qualcare PPO/HMO/WC	$198.25

FLUID SET DUAL SPIKE

Facility

$1,321.65

Hospital Charge Code	270600359
Hospital Revenue Code	270
Min. Negotiated Rate	$171.81
Max. Negotiated Rate	$660.83
Rate for Payer: Aetna Commercial	$396.50
Rate for Payer: Aetna Medicare Advantage	$396.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.02
Rate for Payer: Cigna Commercial	$660.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.81
Rate for Payer: Oxford Commercial	$660.83
Rate for Payer: Qualcare PPO/HMO/WC	$198.25
Rate for Payer: UnitedHealthcare Commercial	$660.83

FLU INTRADERMAL >18 YR

Facility

$99.36

Service Code	HCPCS 90654
Hospital Charge Code	83652309
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$24.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

FLU INTRADERMAL >18 YR

Facility

$99.36

Service Code	HCPCS 90654
Hospital Charge Code	83652309
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$49.68
Rate for Payer: Aetna Commercial	$29.81
Rate for Payer: Aetna Medicare Advantage	$29.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.34
Rate for Payer: Cigna Commercial	$49.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

FLUIONAZOLE ORL SSP 40MG/ML

Facility

$671.40

Hospital Charge Code	6017982
Hospital Revenue Code	252
Min. Negotiated Rate	$100.71
Max. Negotiated Rate	$100.71
Rate for Payer: Qualcare PPO/HMO/WC	$100.71

FLUIONAZOLE ORL SSP 40MG/ML

Facility

$671.40

Hospital Charge Code	6017982
Hospital Revenue Code	252
Min. Negotiated Rate	$87.28
Max. Negotiated Rate	$335.70
Rate for Payer: Aetna Commercial	$201.42
Rate for Payer: Aetna Medicare Advantage	$201.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.21
Rate for Payer: Cigna Commercial	$335.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.28
Rate for Payer: Oxford Commercial	$335.70
Rate for Payer: Qualcare PPO/HMO/WC	$100.71
Rate for Payer: UnitedHealthcare Commercial	$335.70

FLUMADINE/100MG/TAB

Facility

$8.00

Hospital Charge Code	60634986
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

FLUMADINE/100MG/TAB

Facility

$8.00

Hospital Charge Code	60634986
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

FLUMAZENIL 0.1 MG/ML LNJ

Facility

$1,090.43

Service Code	NDC 63323042405
Hospital Charge Code	6007520
Hospital Revenue Code	250
Min. Negotiated Rate	$163.56
Max. Negotiated Rate	$163.56
Rate for Payer: Qualcare PPO/HMO/WC	$163.56

FLUMAZENIL 0.1 MG/ML LNJ

Facility

$1,090.43

Service Code	NDC 63323042405
Hospital Charge Code	6007520
Hospital Revenue Code	250
Min. Negotiated Rate	$141.76
Max. Negotiated Rate	$545.22
Rate for Payer: Aetna Commercial	$327.13
Rate for Payer: Aetna Medicare Advantage	$327.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.06
Rate for Payer: Cigna Commercial	$545.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.76
Rate for Payer: Oxford Commercial	$545.22
Rate for Payer: Qualcare PPO/HMO/WC	$163.56
Rate for Payer: UnitedHealthcare Commercial	$545.22

FLUNISOLIDE 250 MCG/INH AER.M

Facility

$70.00

Hospital Charge Code	60628037
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$21.00
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$35.00

FLUNISOLIDE 250 MCG/INH AER.M

Facility

$70.00

Hospital Charge Code	60628037
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

FLUNISOLIDE INH 7GM

Facility

$367.40

Hospital Charge Code	6002406
Hospital Revenue Code	252
Min. Negotiated Rate	$55.11
Max. Negotiated Rate	$55.11
Rate for Payer: Qualcare PPO/HMO/WC	$55.11

FLUNISOLIDE INH 7GM

Facility

$367.40

Hospital Charge Code	6002406
Hospital Revenue Code	252
Min. Negotiated Rate	$47.76
Max. Negotiated Rate	$183.70
Rate for Payer: Aetna Commercial	$110.22
Rate for Payer: Aetna Medicare Advantage	$110.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.69
Rate for Payer: Cigna Commercial	$183.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.76
Rate for Payer: Oxford Commercial	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$55.11
Rate for Payer: UnitedHealthcare Commercial	$183.70

FLUNISOLIDE NASAL 25 MCG SPRAY

Facility

$282.45

Hospital Charge Code	60628193
Hospital Revenue Code	250
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$141.22
Rate for Payer: Aetna Commercial	$84.73
Rate for Payer: Aetna Medicare Advantage	$84.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.02
Rate for Payer: Cigna Commercial	$141.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.72
Rate for Payer: Oxford Commercial	$141.22
Rate for Payer: Qualcare PPO/HMO/WC	$42.37
Rate for Payer: UnitedHealthcare Commercial	$141.22

FLUNISOLIDE NASAL 25 MCG SPRAY

Facility

$282.45

Hospital Charge Code	60628193
Hospital Revenue Code	250
Min. Negotiated Rate	$42.37
Max. Negotiated Rate	$42.37
Rate for Payer: Qualcare PPO/HMO/WC	$42.37

FLUNISOLIDE ORL INH 250MCG

Facility

$70.00

Hospital Charge Code	60628036
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$21.00
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$35.00

FLUNISOLIDE ORL INH 250MCG

Facility

$70.00

Hospital Charge Code	60628036
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

FLUOCINOLONE ACETONIDE 0.

Facility

$226.26

Service Code	NDC 168006015
Hospital Charge Code	60632999
Hospital Revenue Code	250
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Qualcare PPO/HMO/WC	$33.94

Know your out-of-pocket cost for care.

All Charges