Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLURAZEPAM 30 MG CAP

Facility

$4.00

Hospital Charge Code	60627844
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 30 MG CAP

Facility

$4.00

Hospital Charge Code	60627844
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FLURBIPROFEN 0.03% OPHTH SOLN

Facility

$261.97

Service Code	NDC 11980080103
Hospital Charge Code	60628088
Hospital Revenue Code	250
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$39.30
Rate for Payer: Qualcare PPO/HMO/WC	$39.30

FLURBIPROFEN 0.03% OPHTH SOLN

Facility

$261.97

Service Code	NDC 11980080103
Hospital Charge Code	60628088
Hospital Revenue Code	250
Min. Negotiated Rate	$34.06
Max. Negotiated Rate	$130.99
Rate for Payer: Aetna Commercial	$78.59
Rate for Payer: Aetna Medicare Advantage	$78.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.80
Rate for Payer: Cigna Commercial	$130.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.06
Rate for Payer: Oxford Commercial	$130.99
Rate for Payer: Qualcare PPO/HMO/WC	$39.30
Rate for Payer: UnitedHealthcare Commercial	$130.99

FLURBIPROFEN OPH .03% 2.5ML

Facility

$109.45

Hospital Charge Code	6002505
Hospital Revenue Code	251
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$54.73

FLURBIPROFEN OPH .03% 2.5ML

Facility

$109.45

Hospital Charge Code	6002505
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

FLURO GUID PERCUT DRN/PL CATH

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	2001630
Hospital Revenue Code	320
Min. Negotiated Rate	$126.54
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$1,022.28
Rate for Payer: Aetna Medicare Advantage	$1,022.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$868.94
Rate for Payer: Cigna Commercial	$126.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.14
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FLURO GUID PERCUT DRN/PL CATH

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	2001630
Hospital Revenue Code	320
Min. Negotiated Rate	$511.14
Max. Negotiated Rate	$511.14
Rate for Payer: Qualcare PPO/HMO/WC	$511.14

FLUSH IMPIMG 1ST SCREW

Facility

$725.00

Service Code	HCPCS C1713
Hospital Charge Code	270694628
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

FLUSH IMPIMG 1ST SCREW

Facility

$725.00

Service Code	HCPCS C1713
Hospital Charge Code	270694628
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$217.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

FLUSHING A PORTA CATH/PICC

Facility

$264.80

Service Code	HCPCS 96523
Hospital Charge Code	93500099
Hospital Revenue Code	761
Min. Negotiated Rate	$34.42
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$79.44
Rate for Payer: Aetna Medicare Advantage	$79.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.52
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.42
Rate for Payer: Oxford Commercial	$132.40
Rate for Payer: Qualcare PPO/HMO/WC	$39.72
Rate for Payer: UnitedHealthcare Commercial	$132.40

FLUSHING A PORTA CATH/PICC

Facility

$264.80

Service Code	HCPCS 96523
Hospital Charge Code	93500099
Hospital Revenue Code	761
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$39.72
Rate for Payer: Qualcare PPO/HMO/WC	$39.72

FLUTAMIDE 125 MG CAP

Facility

$18.45

Hospital Charge Code	60627384
Hospital Revenue Code	252
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

FLUTAMIDE 125 MG CAP

Facility

$18.45

Hospital Charge Code	60627384
Hospital Revenue Code	252
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

FLUTE TIP GUIDEWIRE LENGTH 400

Facility

$1,620.00

Service Code	HCPCS C1769
Hospital Charge Code	270687816
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

FLUTE TIP GUIDEWIRE LENGTH 400

Facility

$1,620.00

Service Code	HCPCS C1769
Hospital Charge Code	270687816
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$486.00
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

FLUTICASONE 110MCG AEROSOL

Facility

$345.65

Hospital Charge Code	60629017
Hospital Revenue Code	250
Min. Negotiated Rate	$44.93
Max. Negotiated Rate	$172.82
Rate for Payer: Aetna Commercial	$103.69
Rate for Payer: Aetna Medicare Advantage	$103.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.14
Rate for Payer: Cigna Commercial	$172.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.93
Rate for Payer: Oxford Commercial	$172.82
Rate for Payer: Qualcare PPO/HMO/WC	$51.85
Rate for Payer: UnitedHealthcare Commercial	$172.82

FLUTICASONE 110MCG AEROSOL

Facility

$345.65

Hospital Charge Code	60629017
Hospital Revenue Code	250
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$51.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.85

FLUTICASONE 220 MCG AEROSOL

Facility

$541.65

Hospital Charge Code	60629018
Hospital Revenue Code	250
Min. Negotiated Rate	$70.41
Max. Negotiated Rate	$270.82
Rate for Payer: Aetna Commercial	$162.50
Rate for Payer: Aetna Medicare Advantage	$162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.12
Rate for Payer: Cigna Commercial	$270.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.41
Rate for Payer: Oxford Commercial	$270.82
Rate for Payer: Qualcare PPO/HMO/WC	$81.25
Rate for Payer: UnitedHealthcare Commercial	$270.82

FLUTICASONE 220 MCG AEROSOL

Facility

$541.65

Hospital Charge Code	60629018
Hospital Revenue Code	250
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Qualcare PPO/HMO/WC	$81.25

FLUTICASONE 44MCG AEROSOL

Facility

$271.25

Hospital Charge Code	60628621
Hospital Revenue Code	250
Min. Negotiated Rate	$35.26
Max. Negotiated Rate	$135.62
Rate for Payer: Aetna Commercial	$81.38
Rate for Payer: Aetna Medicare Advantage	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.17
Rate for Payer: Cigna Commercial	$135.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.26
Rate for Payer: Oxford Commercial	$135.62
Rate for Payer: Qualcare PPO/HMO/WC	$40.69
Rate for Payer: UnitedHealthcare Commercial	$135.62

FLUTICASONE 44MCG AEROSOL

Facility

$271.25

Hospital Charge Code	60628621
Hospital Revenue Code	250
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$40.69
Rate for Payer: Qualcare PPO/HMO/WC	$40.69

FLUTICASONE & SALMETERL INH113

Facility

$1,027.91

Service Code	NDC 93360882
Hospital Charge Code	606390251
Hospital Revenue Code	250
Min. Negotiated Rate	$154.19
Max. Negotiated Rate	$154.19
Rate for Payer: Qualcare PPO/HMO/WC	$154.19

FLUTICASONE & SALMETERL INH113

Facility

$1,027.91

Service Code	NDC 93360882
Hospital Charge Code	606390251
Hospital Revenue Code	250
Min. Negotiated Rate	$133.63
Max. Negotiated Rate	$513.96
Rate for Payer: Aetna Commercial	$308.37
Rate for Payer: Aetna Medicare Advantage	$308.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.12
Rate for Payer: Cigna Commercial	$513.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.63
Rate for Payer: Oxford Commercial	$513.96
Rate for Payer: Qualcare PPO/HMO/WC	$154.19
Rate for Payer: UnitedHealthcare Commercial	$513.96

FLUTICASONE & SALMETERL INH232

Facility

$1,027.91

Service Code	NDC 93360982
Hospital Charge Code	606390252
Hospital Revenue Code	250
Min. Negotiated Rate	$154.19
Max. Negotiated Rate	$154.19
Rate for Payer: Qualcare PPO/HMO/WC	$154.19

Know your out-of-pocket cost for care.

All Charges