Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUOCINOLONE ACETONIDE 0.

Facility

$226.26

Service Code	NDC 168006015
Hospital Charge Code	60632999
Hospital Revenue Code	250
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$113.13
Rate for Payer: Aetna Commercial	$67.88
Rate for Payer: Aetna Medicare Advantage	$67.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.70
Rate for Payer: Cigna Commercial	$113.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.41
Rate for Payer: Oxford Commercial	$113.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.94
Rate for Payer: UnitedHealthcare Commercial	$113.13

FLUOCINOLONE CRM 0.01%

Facility

$44.00

Hospital Charge Code	60628380
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

FLUOCINOLONE CRM 0.01%

Facility

$44.00

Hospital Charge Code	60628380
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

FLUOCINOLONE CRM 0.025%

Facility

$168.80

Hospital Charge Code	60628382
Hospital Revenue Code	250
Min. Negotiated Rate	$25.32
Max. Negotiated Rate	$25.32
Rate for Payer: Qualcare PPO/HMO/WC	$25.32

FLUOCINOLONE CRM 0.025%

Facility

$168.80

Hospital Charge Code	60628382
Hospital Revenue Code	250
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$84.40
Rate for Payer: Aetna Commercial	$50.64
Rate for Payer: Aetna Medicare Advantage	$50.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.04
Rate for Payer: Cigna Commercial	$84.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.94
Rate for Payer: Oxford Commercial	$84.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.32
Rate for Payer: UnitedHealthcare Commercial	$84.40

FLUOCINOLONE SOL 0.01%

Facility

$103.25

Hospital Charge Code	60628381
Hospital Revenue Code	250
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

FLUOCINOLONE SOL 0.01%

Facility

$103.25

Hospital Charge Code	60628381
Hospital Revenue Code	250
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$51.62
Rate for Payer: Aetna Commercial	$30.98
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$51.62
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$51.62

FLUOCINOLONE SOLUTION

Facility

$26.00

Hospital Charge Code	60634925
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

FLUOCINOLONE SOLUTION

Facility

$26.00

Hospital Charge Code	60634925
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

FLUOCINOLONE TOP 60GM

Facility

$21.15

Hospital Charge Code	6002414
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

FLUOCINOLONE TOP 60GM

Facility

$21.15

Hospital Charge Code	6002414
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

FLUOCINONIDE 0.05%/15GM

Facility

$34.00

Hospital Charge Code	60633000
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

FLUOCINONIDE 0.05%/15GM

Facility

$34.00

Hospital Charge Code	60633000
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

FLUOCINONIDE 0.05%/30GM

Facility

$43.00

Hospital Charge Code	60633001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

FLUOCINONIDE 0.05%/30GM

Facility

$43.00

Hospital Charge Code	60633001
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

FLUOCINONIDE 0.05 % CRE

Facility

$224.00

Hospital Charge Code	60628384
Hospital Revenue Code	250
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$67.20
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.12
Rate for Payer: Oxford Commercial	$112.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$112.00

FLUOCINONIDE 0.05 % CRE

Facility

$224.00

Hospital Charge Code	60628384
Hospital Revenue Code	250
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

FLUOCINONIDE 0.05 % CREAM

Facility

$172.00

Hospital Charge Code	60628385
Hospital Revenue Code	250
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$51.60
Rate for Payer: Aetna Medicare Advantage	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.36
Rate for Payer: Oxford Commercial	$86.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$86.00

FLUOCINONIDE 0.05 % CREAM

Facility

$172.00

Hospital Charge Code	60628385
Hospital Revenue Code	250
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

fLUOCINONIDE 0.05% CREAM 15G

Facility

$305.19

Service Code	NDC 51672125301
Hospital Charge Code	60630178
Hospital Revenue Code	250
Min. Negotiated Rate	$45.78
Max. Negotiated Rate	$45.78
Rate for Payer: Qualcare PPO/HMO/WC	$45.78

fLUOCINONIDE 0.05% CREAM 15G

Facility

$305.19

Service Code	NDC 51672125301
Hospital Charge Code	60630178
Hospital Revenue Code	250
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$152.59
Rate for Payer: Aetna Commercial	$91.56
Rate for Payer: Aetna Medicare Advantage	$91.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.82
Rate for Payer: Cigna Commercial	$152.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.67
Rate for Payer: Oxford Commercial	$152.59
Rate for Payer: Qualcare PPO/HMO/WC	$45.78
Rate for Payer: UnitedHealthcare Commercial	$152.59

FLUOCINONIDE 0.05% OIN

Facility

$225.65

Hospital Charge Code	60628386
Hospital Revenue Code	250
Min. Negotiated Rate	$29.33
Max. Negotiated Rate	$112.83
Rate for Payer: Aetna Commercial	$67.69
Rate for Payer: Aetna Medicare Advantage	$67.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.54
Rate for Payer: Cigna Commercial	$112.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.33
Rate for Payer: Oxford Commercial	$112.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.85
Rate for Payer: UnitedHealthcare Commercial	$112.83

FLUOCINONIDE 0.05% OIN

Facility

$225.65

Hospital Charge Code	60628386
Hospital Revenue Code	250
Min. Negotiated Rate	$33.85
Max. Negotiated Rate	$33.85
Rate for Payer: Qualcare PPO/HMO/WC	$33.85

FLUOCINONIDE 0.05% OINTMENT 15

Facility

$191.15

Service Code	NDC 168014015
Hospital Charge Code	60630177
Hospital Revenue Code	250
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$95.58
Rate for Payer: Aetna Commercial	$57.34
Rate for Payer: Aetna Medicare Advantage	$57.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.74
Rate for Payer: Cigna Commercial	$95.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.85
Rate for Payer: Oxford Commercial	$95.58
Rate for Payer: Qualcare PPO/HMO/WC	$28.67
Rate for Payer: UnitedHealthcare Commercial	$95.58

FLUOCINONIDE 0.05% OINTMENT 15

Facility

$191.15

Service Code	NDC 168014015
Hospital Charge Code	60630177
Hospital Revenue Code	250
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$28.67
Rate for Payer: Qualcare PPO/HMO/WC	$28.67

Know your out-of-pocket cost for care.

All Charges