Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUOXETINE 20 MG CAP

Facility

$17.89

Service Code	NDC 777310502
Hospital Charge Code	6010383
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$5.37
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$8.95

FLUOXETINE 20 MG CAP

Facility

$17.89

Service Code	NDC 777310502
Hospital Charge Code	6010383
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

FLUOXETINE LQ 20MG/5ML 120ML

Facility

$1,016.35

Hospital Charge Code	6010276
Hospital Revenue Code	252
Min. Negotiated Rate	$152.45
Max. Negotiated Rate	$152.45
Rate for Payer: Qualcare PPO/HMO/WC	$152.45

FLUOXETINE LQ 20MG/5ML 120ML

Facility

$1,016.35

Hospital Charge Code	6010276
Hospital Revenue Code	252
Min. Negotiated Rate	$132.13
Max. Negotiated Rate	$508.18
Rate for Payer: Aetna Commercial	$304.90
Rate for Payer: Aetna Medicare Advantage	$304.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.17
Rate for Payer: Cigna Commercial	$508.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.13
Rate for Payer: Oxford Commercial	$508.18
Rate for Payer: Qualcare PPO/HMO/WC	$152.45
Rate for Payer: UnitedHealthcare Commercial	$508.18

FLUOXETINE (NORFLUOX/PROZAC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3009198
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

FLUOXETINE (NORFLUOX/PROZAC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3009198
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

FLUOXETINE,SERUM (PROZAC)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473104
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

FLUOXETINE,SERUM (PROZAC)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473104
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

FLUOXYMESTERONE 10 MG TAB

Facility

$18.45

Hospital Charge Code	60628213
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

FLUOXYMESTERONE 10 MG TAB

Facility

$18.45

Hospital Charge Code	60628213
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$9.22

FLUOXYMESTERONE TAB 10MG

Facility

$15.40

Hospital Charge Code	6009401
Hospital Revenue Code	252
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

FLUOXYMESTERONE TAB 10MG

Facility

$15.40

Hospital Charge Code	6009401
Hospital Revenue Code	252
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

FLUPHENAZIN DEC25MG/ML INJ 5ML

Facility

$160.80

Service Code	HCPCS J2680
Hospital Charge Code	60627795
Hospital Revenue Code	636
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$38.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

FLUPHENAZIN DEC25MG/ML INJ 5ML

Facility

$160.80

Service Code	HCPCS J2680
Hospital Charge Code	60627795
Hospital Revenue Code	636
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$48.24
Rate for Payer: Aetna Commercial	$48.24
Rate for Payer: Aetna Medicare Advantage	$48.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.00
Rate for Payer: Cigna Commercial	$5.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

FLUPHENAZINE 10 MG TAB

Facility

$11.19

Service Code	NDC 378609701
Hospital Charge Code	60628980
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$5.59
Rate for Payer: Aetna Commercial	$3.36
Rate for Payer: Aetna Medicare Advantage	$3.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.85
Rate for Payer: Cigna Commercial	$5.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.68
Rate for Payer: UnitedHealthcare Commercial	$5.59

FLUPHENAZINE 10 MG TAB

Facility

$11.19

Service Code	NDC 378609701
Hospital Charge Code	60628980
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Qualcare PPO/HMO/WC	$1.68

FLUPHENAZINE 1 MG TAB

Facility

$4.22

Service Code	NDC 378600401
Hospital Charge Code	60627796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.55
Rate for Payer: Oxford Commercial	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$2.11

FLUPHENAZINE 1 MG TAB

Facility

$4.22

Service Code	NDC 378600401
Hospital Charge Code	60627796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

FLUPHENAZINE 2.5 MG TAB

Facility

$4.62

Service Code	NDC 51079048620
Hospital Charge Code	6027023
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

FLUPHENAZINE 2.5 MG TAB

Facility

$4.62

Service Code	NDC 51079048620
Hospital Charge Code	6027023
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.39
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$2.31

FLUPHENAZINE 5MG/ML ORAL SOL

Facility

$21.04

Service Code	NDC 121065304
Hospital Charge Code	6063943111
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$10.52
Rate for Payer: Aetna Commercial	$6.31
Rate for Payer: Aetna Medicare Advantage	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.37
Rate for Payer: Cigna Commercial	$10.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.74
Rate for Payer: Oxford Commercial	$10.52
Rate for Payer: Qualcare PPO/HMO/WC	$3.16
Rate for Payer: UnitedHealthcare Commercial	$10.52

FLUPHENAZINE 5MG/ML ORAL SOL

Facility

$21.04

Service Code	NDC 121065304
Hospital Charge Code	6063943111
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.16

FLUPHENAZINE 5 MG TAB

Facility

$5.36

Service Code	NDC 51079048720
Hospital Charge Code	6027015
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

FLUPHENAZINE 5 MG TAB

Facility

$5.36

Service Code	NDC 51079048720
Hospital Charge Code	6027015
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$1.61
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.68

FLUPHENAZINE/5MG/TAB

Facility

$5.00

Hospital Charge Code	60633006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

Know your out-of-pocket cost for care.

All Charges