Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUOROSCOPY

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	7411167
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROSCOPY UP TO 1 HR

Facility

$6,601.19

Service Code	HCPCS 76000
Hospital Charge Code	2000636
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FLUOROSCOPY UP TO 1 HR

Facility

$6,601.19

Service Code	HCPCS 76000
Hospital Charge Code	2000636
Hospital Revenue Code	320
Min. Negotiated Rate	$92.56
Max. Negotiated Rate	$1,980.36
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FLUOROTOME SPHINCTEROTOMY 5382

Facility

$1,719.25

Hospital Charge Code	270600930
Hospital Revenue Code	270
Min. Negotiated Rate	$257.89
Max. Negotiated Rate	$257.89
Rate for Payer: Qualcare PPO/HMO/WC	$257.89

FLUOROTOME SPHINCTEROTOMY 5382

Facility

$1,719.25

Hospital Charge Code	270600930
Hospital Revenue Code	270
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$859.62
Rate for Payer: Aetna Commercial	$515.77
Rate for Payer: Aetna Medicare Advantage	$515.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.41
Rate for Payer: Cigna Commercial	$859.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.50
Rate for Payer: Oxford Commercial	$859.62
Rate for Payer: Qualcare PPO/HMO/WC	$257.89
Rate for Payer: UnitedHealthcare Commercial	$859.62

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2690260
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2690260
Hospital Revenue Code	320
Min. Negotiated Rate	$92.56
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	321076000
Hospital Revenue Code	320
Min. Negotiated Rate	$92.56
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	321076000
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROURACIL 500 MG/10 ML INJ

Facility

$24.12

Service Code	HCPCS J9190
Hospital Charge Code	60627383
Hospital Revenue Code	636
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$7.24
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$2.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

FLUOROURACIL 500 MG/10 ML INJ

Facility

$24.12

Service Code	HCPCS J9190
Hospital Charge Code	60627383
Hospital Revenue Code	636
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$5.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

FLUOROURACIL/50MG/1ML

Facility

$21.00

Hospital Charge Code	60633004
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

FLUOROURACIL/50MG/1ML

Facility

$21.00

Hospital Charge Code	60633004
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

FLUOROURACIL CRM 30GM

Facility

$219.55

Hospital Charge Code	6007090
Hospital Revenue Code	250
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$109.78
Rate for Payer: Aetna Commercial	$65.86
Rate for Payer: Aetna Medicare Advantage	$65.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.99
Rate for Payer: Cigna Commercial	$109.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.54
Rate for Payer: Oxford Commercial	$109.78
Rate for Payer: Qualcare PPO/HMO/WC	$32.93
Rate for Payer: UnitedHealthcare Commercial	$109.78

FLUOROURACIL CRM 30GM

Facility

$219.55

Hospital Charge Code	6007090
Hospital Revenue Code	250
Min. Negotiated Rate	$32.93
Max. Negotiated Rate	$32.93
Rate for Payer: Qualcare PPO/HMO/WC	$32.93

FLUOROURACIL INJ 500MG

Facility

$89.00

Hospital Charge Code	6009542
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

FLUOROURACIL INJ 500MG

Facility

$89.00

Hospital Charge Code	6009542
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

FLUOTHANE/125ML

Facility

$244.00

Hospital Charge Code	60633005
Hospital Revenue Code	250
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

FLUOTHANE/125ML

Facility

$244.00

Hospital Charge Code	60633005
Hospital Revenue Code	250
Min. Negotiated Rate	$31.72
Max. Negotiated Rate	$122.00
Rate for Payer: Aetna Commercial	$73.20
Rate for Payer: Aetna Medicare Advantage	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.22
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.72
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$122.00

FLUOXETINE***

Facility

$116.00

Hospital Charge Code	3010592
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.58
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

FLUOXETINE***

Facility

$116.00

Hospital Charge Code	3010592
Hospital Revenue Code	301
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

FLUOXETINE 10 MG CAP

Facility

$70.02

Service Code	NDC 777310402
Hospital Charge Code	60627765
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

FLUOXETINE 10 MG CAP

Facility

$70.02

Service Code	NDC 777310402
Hospital Charge Code	60627765
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$35.01
Rate for Payer: Aetna Commercial	$21.01
Rate for Payer: Aetna Medicare Advantage	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.86
Rate for Payer: Cigna Commercial	$35.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$35.01
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$35.01

FLUOXETINE 20 MG/5 ML ELIX

Facility

$32.83

Service Code	NDC 121072104
Hospital Charge Code	60628620
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$4.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.92

FLUOXETINE 20 MG/5 ML ELIX

Facility

$32.83

Service Code	NDC 121072104
Hospital Charge Code	60628620
Hospital Revenue Code	250
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$16.41
Rate for Payer: Aetna Commercial	$9.85
Rate for Payer: Aetna Medicare Advantage	$9.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.37
Rate for Payer: Cigna Commercial	$16.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.27
Rate for Payer: Oxford Commercial	$16.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.92
Rate for Payer: UnitedHealthcare Commercial	$16.41

Know your out-of-pocket cost for care.

All Charges