Heights University Hospital

All Charges

Charge

Type

Setting

Price

FORTOVASE 200MG CAP

Facility

$4.00

Hospital Charge Code	60635480
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FORTOVASE 200MG CAP

Facility

$4.00

Hospital Charge Code	60635480
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

FOSAMAX 35MG

Facility

$18.00

Hospital Charge Code	60635498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

FOSAMAX 35MG

Facility

$18.00

Hospital Charge Code	60635498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

FOSAMAX 5MG TABLET

Facility

$3.00

Hospital Charge Code	60635414
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FOSAMAX 5MG TABLET

Facility

$3.00

Hospital Charge Code	60635414
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

FOSAMAX, 70MG TABLET

Facility

$25.00

Hospital Charge Code	60635417
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

FOSAMAX, 70MG TABLET

Facility

$25.00

Hospital Charge Code	60635417
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

FOSAMAX TABS

Facility

$9.00

Hospital Charge Code	60635068
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

FOSAMAX TABS

Facility

$9.00

Hospital Charge Code	60635068
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FOSAPREPITANT DIMEGLUMIN 150MG

Facility

$2,065.95

Service Code	HCPCS J1453
Hospital Charge Code	60630084
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$619.78
Rate for Payer: Aetna Commercial	$619.78
Rate for Payer: Aetna Medicare Advantage	$619.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.82
Rate for Payer: Cigna Commercial	$0.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.96
Rate for Payer: Qualcare PPO/HMO/WC	$309.89

FOSAPREPITANT DIMEGLUMIN 150MG

Facility

$2,065.95

Service Code	HCPCS J1453
Hospital Charge Code	60630084
Hospital Revenue Code	636
Min. Negotiated Rate	$309.89
Max. Negotiated Rate	$499.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.96
Rate for Payer: Qualcare PPO/HMO/WC	$309.89

FOSCAVIR INJ

Facility

$994.00

Hospital Charge Code	60635090
Hospital Revenue Code	636
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$497.00
Rate for Payer: Aetna Commercial	$298.20
Rate for Payer: Aetna Medicare Advantage	$298.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.47
Rate for Payer: Cigna Commercial	$497.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.55
Rate for Payer: Qualcare PPO/HMO/WC	$149.10

FOSCAVIR INJ

Facility

$994.00

Hospital Charge Code	60635090
Hospital Revenue Code	636
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$240.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.55
Rate for Payer: Qualcare PPO/HMO/WC	$149.10

FOSFOMYCIN 3G

Facility

$267.45

Hospital Charge Code	60630235
Hospital Revenue Code	250
Min. Negotiated Rate	$40.12
Max. Negotiated Rate	$40.12
Rate for Payer: Qualcare PPO/HMO/WC	$40.12

FOSFOMYCIN 3G

Facility

$267.45

Hospital Charge Code	60630235
Hospital Revenue Code	250
Min. Negotiated Rate	$34.77
Max. Negotiated Rate	$133.72
Rate for Payer: Aetna Commercial	$80.23
Rate for Payer: Aetna Medicare Advantage	$80.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.20
Rate for Payer: Cigna Commercial	$133.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.77
Rate for Payer: Oxford Commercial	$133.72
Rate for Payer: Qualcare PPO/HMO/WC	$40.12
Rate for Payer: UnitedHealthcare Commercial	$133.72

FOSFOMYCIN 3GM PACKET

Facility

$486.49

Service Code	NDC 456430001
Hospital Charge Code	6063943345
Hospital Revenue Code	250
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$243.25
Rate for Payer: Aetna Commercial	$145.95
Rate for Payer: Aetna Medicare Advantage	$145.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.05
Rate for Payer: Cigna Commercial	$243.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.24
Rate for Payer: Oxford Commercial	$243.25
Rate for Payer: Qualcare PPO/HMO/WC	$72.97
Rate for Payer: UnitedHealthcare Commercial	$243.25

FOSFOMYCIN 3GM PACKET

Facility

$486.49

Service Code	NDC 456430001
Hospital Charge Code	6063943345
Hospital Revenue Code	250
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$72.97
Rate for Payer: Qualcare PPO/HMO/WC	$72.97

FOSINOPRIL 10 MG TAB

Facility

$9.65

Hospital Charge Code	60627566
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

FOSINOPRIL 10 MG TAB

Facility

$9.65

Hospital Charge Code	60627566
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

FOSINOPRIL 20 MG TAB

Facility

$9.65

Hospital Charge Code	60627567
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

FOSINOPRIL 20 MG TAB

Facility

$9.65

Hospital Charge Code	60627567
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

FOSINOPRIL SODIUM TAB 10MG

Facility

$7.70

Hospital Charge Code	6017941
Hospital Revenue Code	252
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

FOSINOPRIL SODIUM TAB 10MG

Facility

$7.70

Hospital Charge Code	6017941
Hospital Revenue Code	252
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

FOSPHENYTOIN 100 MG/2ML INJ

Facility

$192.83

Service Code	HCPCS Q2009
Hospital Charge Code	6017610
Hospital Revenue Code	636
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$57.85
Rate for Payer: Aetna Commercial	$57.85
Rate for Payer: Aetna Medicare Advantage	$57.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.66
Rate for Payer: Qualcare PPO/HMO/WC	$28.92

Know your out-of-pocket cost for care.

All Charges