Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUPHENAZINE/5MG/TAB

Facility

$5.00

Hospital Charge Code	60633006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

FLUPHENAZINE DC INJ 25MG/ML 5M

Facility

$149.15

Hospital Charge Code	6002471
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$22.37
Rate for Payer: Qualcare PPO/HMO/WC	$22.37

FLUPHENAZINE DC INJ 25MG/ML 5M

Facility

$149.15

Hospital Charge Code	6002471
Hospital Revenue Code	250
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$74.58
Rate for Payer: Aetna Commercial	$44.74
Rate for Payer: Aetna Medicare Advantage	$44.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.03
Rate for Payer: Cigna Commercial	$74.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.39
Rate for Payer: Oxford Commercial	$74.58
Rate for Payer: Qualcare PPO/HMO/WC	$22.37
Rate for Payer: UnitedHealthcare Commercial	$74.58

FLUPHENAZINE ELX 0.5 MG/ML

Facility

$234.25

Hospital Charge Code	6011027
Hospital Revenue Code	251
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$35.14
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

FLUPHENAZINE ELX 0.5 MG/ML

Facility

$234.25

Hospital Charge Code	6011027
Hospital Revenue Code	251
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$70.28
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.73
Rate for Payer: Cigna Commercial	$117.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.45
Rate for Payer: Oxford Commercial	$117.12
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Commercial	$117.12

FLUPHENAZINE ELX 2.5MG/5ML

Facility

$21.44

Service Code	NDC 121065402
Hospital Charge Code	60627797
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$6.43
Rate for Payer: Aetna Medicare Advantage	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.47
Rate for Payer: Cigna Commercial	$10.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$10.72
Rate for Payer: Qualcare PPO/HMO/WC	$3.22
Rate for Payer: UnitedHealthcare Commercial	$10.72

FLUPHENAZINE ELX 2.5MG/5ML

Facility

$21.44

Service Code	NDC 121065402
Hospital Charge Code	60627797
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

FLUPHENAZINE ELX 5MG/ML

Facility

$6.40

Hospital Charge Code	60627799
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$3.20
Rate for Payer: Aetna Commercial	$1.92
Rate for Payer: Aetna Medicare Advantage	$1.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.63
Rate for Payer: Cigna Commercial	$3.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.83
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$3.20

FLUPHENAZINE ELX 5MG/ML

Facility

$6.40

Hospital Charge Code	60627799
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

FLUPHENAZINE INJ 25MG/10ML

Facility

$26.45

Hospital Charge Code	60627798
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$7.93
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.44
Rate for Payer: Oxford Commercial	$13.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$13.22

FLUPHENAZINE INJ 25MG/10ML

Facility

$26.45

Hospital Charge Code	60627798
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

FLUPHENAZINE,URINE

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000777
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

FLUPHENAZINE,URINE

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000777
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$114.00

FLURANDRENOLIDE 0.05 % OIN

Facility

$131.25

Hospital Charge Code	60628387
Hospital Revenue Code	250
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

FLURANDRENOLIDE 0.05 % OIN

Facility

$131.25

Hospital Charge Code	60628387
Hospital Revenue Code	250
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$39.38
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Oxford Commercial	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$65.62

FLURANDRENOLIDE TAPE 4MCG

Facility

$229.80

Hospital Charge Code	6002497
Hospital Revenue Code	252
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$114.90
Rate for Payer: Aetna Commercial	$68.94
Rate for Payer: Aetna Medicare Advantage	$68.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.60
Rate for Payer: Cigna Commercial	$114.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.87
Rate for Payer: Oxford Commercial	$114.90
Rate for Payer: Qualcare PPO/HMO/WC	$34.47
Rate for Payer: UnitedHealthcare Commercial	$114.90

FLURANDRENOLIDE TAPE 4MCG

Facility

$229.80

Hospital Charge Code	6002497
Hospital Revenue Code	252
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$34.47
Rate for Payer: Qualcare PPO/HMO/WC	$34.47

FLURANDRENOLIDE TOP .05% 60ML

Facility

$254.75

Hospital Charge Code	6002489
Hospital Revenue Code	252
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$38.21
Rate for Payer: Qualcare PPO/HMO/WC	$38.21

FLURANDRENOLIDE TOP .05% 60ML

Facility

$254.75

Hospital Charge Code	6002489
Hospital Revenue Code	252
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$127.38
Rate for Payer: Aetna Commercial	$76.42
Rate for Payer: Aetna Medicare Advantage	$76.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.96
Rate for Payer: Cigna Commercial	$127.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.12
Rate for Payer: Oxford Commercial	$127.38
Rate for Payer: Qualcare PPO/HMO/WC	$38.21
Rate for Payer: UnitedHealthcare Commercial	$127.38

FLURATE OPH SOL 0.25% B&L 5ML

Facility

$46.75

Hospital Charge Code	60629352
Hospital Revenue Code	250
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$23.38
Rate for Payer: Aetna Commercial	$14.03
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.08
Rate for Payer: Oxford Commercial	$23.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Commercial	$23.38

FLURATE OPH SOL 0.25% B&L 5ML

Facility

$46.75

Hospital Charge Code	60629352
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$7.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

FLURAZEPAM 15MG

Facility

$1.95

Hospital Charge Code	6021117
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

FLURAZEPAM 15MG

Facility

$1.95

Hospital Charge Code	6021117
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

FLURAZEPAM 15 MG CAP

Facility

$4.00

Hospital Charge Code	60629105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

FLURAZEPAM 15 MG CAP

Facility

$4.00

Hospital Charge Code	60629105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges