Heights University Hospital

All Charges

Charge

Type

Setting

Price

FUROSEMIDE 100 MG/10ML INJ

Facility

$18.83

Service Code	HCPCS J1941
Hospital Charge Code	60627964
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$9.41
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: Aetna Medicare Advantage	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Commercial	$9.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

FUROSEMIDE 100 MG/10ML INJ

Facility

$18.83

Service Code	HCPCS J1941
Hospital Charge Code	60627964
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

FUROSEMIDE/10MG/1ML

Facility

$13.00

Hospital Charge Code	60633026
Hospital Revenue Code	636
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

FUROSEMIDE/10MG/1ML

Facility

$8.00

Hospital Charge Code	60633027
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

FUROSEMIDE/10MG/1ML

Facility

$8.00

Hospital Charge Code	60633027
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

FUROSEMIDE/10MG/1ML

Facility

$7.00

Hospital Charge Code	60633025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

FUROSEMIDE/10MG/1ML

Facility

$13.00

Hospital Charge Code	60633026
Hospital Revenue Code	636
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$3.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

FUROSEMIDE/10MG/1ML

Facility

$7.00

Hospital Charge Code	60633025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

FUROSEMIDE 10 MG/ML LIQ (60ML)

Facility

$60.97

Service Code	NDC 54329446
Hospital Charge Code	60627965
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

FUROSEMIDE 10 MG/ML LIQ (60ML)

Facility

$60.97

Service Code	NDC 54329446
Hospital Charge Code	60627965
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.48
Rate for Payer: Aetna Commercial	$18.29
Rate for Payer: Aetna Medicare Advantage	$18.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.48
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.48

FUROSEMIDE 20 MG/2ML INJ

Facility

$21.98

Service Code	HCPCS J1941
Hospital Charge Code	6002547
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$5.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

FUROSEMIDE 20 MG/2ML INJ

Facility

$21.98

Service Code	HCPCS J1941
Hospital Charge Code	6002547
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$6.59
Rate for Payer: Aetna Medicare Advantage	$6.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.60
Rate for Payer: Cigna Commercial	$10.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

FUROSEMIDE 20 MG TAB

Facility

$4.00

Service Code	NDC 54829725
Hospital Charge Code	6023071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FUROSEMIDE 20 MG TAB

Facility

$4.00

Service Code	NDC 54829725
Hospital Charge Code	6023071
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

FUROSEMIDE/20MG/TAB

Facility

$3.00

Hospital Charge Code	60633023
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

FUROSEMIDE/20MG/TAB

Facility

$3.00

Hospital Charge Code	60633023
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FUROSEMIDE/20MG/TAB

Facility

$4.00

Hospital Charge Code	60633020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FUROSEMIDE/20MG/TAB

Facility

$4.00

Hospital Charge Code	60633020
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

FUROSEMIDE/40MG/4ML

Facility

$5.00

Hospital Charge Code	60633022
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
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	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

FUROSEMIDE/40MG/4ML

Facility

$5.00

Hospital Charge Code	60633022
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

FUROSEMIDE 40 MG/4ML INJ

Facility

$14.67

Service Code	HCPCS J1941
Hospital Charge Code	60627967
Hospital Revenue Code	636
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$4.40
Rate for Payer: Aetna Medicare Advantage	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.74
Rate for Payer: Cigna Commercial	$7.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.20

FUROSEMIDE 40 MG/4ML INJ

Facility

$14.67

Service Code	HCPCS J1941
Hospital Charge Code	60627967
Hospital Revenue Code	636
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.20

FUROSEMIDE 40MG/4ML ORAL SOLN

Facility

$16.48

Service Code	NDC 68094075659
Hospital Charge Code	606380020
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

FUROSEMIDE 40MG/4ML ORAL SOLN

Facility

$16.48

Service Code	NDC 68094075659
Hospital Charge Code	606380020
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$8.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$8.24

FUROSEMIDE 40MG/5ML LIQUID U/D

Facility

$11.93

Service Code	NDC 54829816
Hospital Charge Code	60629311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna Commercial	$3.58
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.04
Rate for Payer: Cigna Commercial	$5.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.55
Rate for Payer: Oxford Commercial	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.79
Rate for Payer: UnitedHealthcare Commercial	$5.96

Know your out-of-pocket cost for care.

All Charges