Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUTICASONE & SALMETERL INH232

Facility

$1,027.91

Service Code	NDC 93360982
Hospital Charge Code	606390252
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 & SALMETEROL INH55

Facility

$1,027.91

Service Code	NDC 93360782
Hospital Charge Code	606390250
Hospital Revenue Code	250
Min. Negotiated Rate	$154.19
Max. Negotiated Rate	$154.19
Rate for Payer: Qualcare PPO/HMO/WC	$154.19

FLUTICASONE & SALMETEROL INH55

Facility

$1,027.91

Service Code	NDC 93360782
Hospital Charge Code	606390250
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

FLU VACC.TRIVALENT(A&B)'05-'06

Facility

$42.65

Service Code	HCPCS 90658
Hospital Charge Code	60629841
Hospital Revenue Code	636
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.40

FLU VACC.TRIVALENT(A&B)'05-'06

Facility

$42.65

Service Code	HCPCS 90658
Hospital Charge Code	60629841
Hospital Revenue Code	636
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$12.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.88
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.40

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$107.20

Service Code	HCPCS 90658
Hospital Charge Code	83652313
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$32.16
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$107.20

Service Code	HCPCS 90658
Hospital Charge Code	83652313
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$76.92

Service Code	HCPCS 90657
Hospital Charge Code	83652605
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$18.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$76.92

Service Code	HCPCS 90657
Hospital Charge Code	83652605
Hospital Revenue Code	636
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$28.11
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna Medicare Advantage	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.61
Rate for Payer: Cigna Commercial	$11.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

FLUVOXAMINE 100 MG TAB

Facility

$17.69

Service Code	NDC 51079099320
Hospital Charge Code	60628831
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$5.31
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.30
Rate for Payer: Oxford Commercial	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$8.85

FLUVOXAMINE 100 MG TAB

Facility

$17.69

Service Code	NDC 51079099320
Hospital Charge Code	60628831
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

FLUVOXAMINE 25 MG TAB

Facility

$15.41

Service Code	NDC 62559015801
Hospital Charge Code	606390053
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.71
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	$7.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.71

FLUVOXAMINE 25 MG TAB

Facility

$15.41

Service Code	NDC 62559015801
Hospital Charge Code	606390053
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

FLUVOXAMINE 50MG

Facility

$17.95

Hospital Charge Code	6016463
Hospital Revenue Code	252
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

FLUVOXAMINE 50MG

Facility

$17.95

Hospital Charge Code	6016463
Hospital Revenue Code	252
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

FLUVOXAMINE 50 MG TAB

Facility

$17.22

Service Code	NDC 51079099220
Hospital Charge Code	60627766
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.58

FLUVOXAMINE 50 MG TAB

Facility

$17.22

Service Code	NDC 51079099220
Hospital Charge Code	60627766
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$8.61
Rate for Payer: Aetna Commercial	$5.17
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.39
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.24
Rate for Payer: Oxford Commercial	$8.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.58
Rate for Payer: UnitedHealthcare Commercial	$8.61

FLUVOXAMINE TAB 25MG

Facility

$14.75

Hospital Charge Code	60628832
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$7.38

FLUVOXAMINE TAB 25MG

Facility

$14.75

Hospital Charge Code	60628832
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

FLUVOXAMINE TAB 50MG

Facility

$57.00

Hospital Charge Code	6010573
Hospital Revenue Code	252
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

FLUVOXAMINE TAB 50MG

Facility

$57.00

Hospital Charge Code	6010573
Hospital Revenue Code	252
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Oxford Commercial	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$28.50

FLUZONE P 0.5ML

Facility

$104.39

Service Code	HCPCS 90655
Hospital Charge Code	606350927
Hospital Revenue Code	636
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$25.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.66

FLUZONE P 0.5ML

Facility

$104.39

Service Code	HCPCS 90655
Hospital Charge Code	606350927
Hospital Revenue Code	636
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna Commercial	$31.32
Rate for Payer: Aetna Medicare Advantage	$31.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.62
Rate for Payer: Cigna Commercial	$52.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.66

FLUZONE TRIVALANT HD 0.5 ML

Facility

$442.20

Service Code	NDC 49281012488
Hospital Charge Code	6063943392
Hospital Revenue Code	250
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$221.10
Rate for Payer: Aetna Commercial	$132.66
Rate for Payer: Aetna Medicare Advantage	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.49
Rate for Payer: Oxford Commercial	$221.10
Rate for Payer: Qualcare PPO/HMO/WC	$66.33
Rate for Payer: UnitedHealthcare Commercial	$221.10

FLUZONE TRIVALANT HD 0.5 ML

Facility

$442.20

Service Code	NDC 49281012488
Hospital Charge Code	6063943392
Hospital Revenue Code	250
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

Know your out-of-pocket cost for care.

All Charges