Heights University Hospital

All Charges

Charge

Type

Setting

Price

NAPHAZOLINE ANTAZOLINE OPH SOL

Facility

$64.65

Hospital Charge Code	60628075
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$9.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.70

NAPHAZOLINE ANTAZOLINE OPH SOL

Facility

$64.65

Hospital Charge Code	60628075
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$32.33
Rate for Payer: Aetna Commercial	$19.39
Rate for Payer: Aetna Medicare Advantage	$19.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.49
Rate for Payer: Cigna Commercial	$32.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$32.33
Rate for Payer: Qualcare PPO/HMO/WC	$9.70
Rate for Payer: UnitedHealthcare Commercial	$32.33

NAPHAZOLINE OPH SOL 0.012%

Facility

$119.25

Hospital Charge Code	60628074
Hospital Revenue Code	250
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

NAPHAZOLINE OPH SOL 0.012%

Facility

$119.25

Hospital Charge Code	60628074
Hospital Revenue Code	250
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$59.62
Rate for Payer: Aetna Commercial	$35.77
Rate for Payer: Aetna Medicare Advantage	$35.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.41
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$59.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$59.62

NAPHAZOLINE OPH SOL .1% 15ML

Facility

$9.65

Hospital Charge Code	6003883
Hospital Revenue Code	252
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

NAPHAZOLINE OPH SOL .1% 15ML

Facility

$9.65

Hospital Charge Code	6003883
Hospital Revenue Code	252
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

NAPHAZOLINE-PHENIRAMINE OPH S

Facility

$127.37

Service Code	NDC 52959010703
Hospital Charge Code	60628837
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$63.69
Rate for Payer: Aetna Commercial	$38.21
Rate for Payer: Aetna Medicare Advantage	$38.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.48
Rate for Payer: Cigna Commercial	$63.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.56
Rate for Payer: Oxford Commercial	$63.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.11
Rate for Payer: UnitedHealthcare Commercial	$63.69

NAPHAZOLINE-PHENIRAMINE OPH S

Facility

$127.37

Service Code	NDC 52959010703
Hospital Charge Code	60628837
Hospital Revenue Code	250
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$19.11
Rate for Payer: Qualcare PPO/HMO/WC	$19.11

NAPHCON

Facility

$13.00

Hospital Charge Code	60634864
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
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	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

NAPHCON

Facility

$13.00

Hospital Charge Code	60634864
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

NAPHCON A/15ML

Facility

$48.00

Hospital Charge Code	60634550
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

NAPHCON A/15ML

Facility

$48.00

Hospital Charge Code	60634550
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

NAPHCON FORTE 0.1% OPHTH

Facility

$71.00

Hospital Charge Code	60633493
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

NAPHCON FORTE 0.1% OPHTH

Facility

$71.00

Hospital Charge Code	60633493
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

NA POLYSTYRENE SULF PWDR 15GM

Facility

$90.52

Service Code	NDC 10702003615
Hospital Charge Code	606390210
Hospital Revenue Code	250
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$45.26
Rate for Payer: Aetna Commercial	$27.16
Rate for Payer: Aetna Medicare Advantage	$27.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.08
Rate for Payer: Cigna Commercial	$45.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.77
Rate for Payer: Oxford Commercial	$45.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.58
Rate for Payer: UnitedHealthcare Commercial	$45.26

NA POLYSTYRENE SULF PWDR 15GM

Facility

$90.52

Service Code	NDC 10702003615
Hospital Charge Code	606390210
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$13.58

NAPROSYN/250MG/TAB

Facility

$6.00

Hospital Charge Code	60633497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

NAPROSYN/250MG/TAB

Facility

$6.00

Hospital Charge Code	60633497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

NAPROSYN/375MG/TAB

Facility

$6.00

Hospital Charge Code	60635876
Hospital Revenue Code	259
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

NAPROSYN/375MG/TAB

Facility

$6.00

Hospital Charge Code	60633494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

NAPROSYN/375MG/TAB

Facility

$6.00

Hospital Charge Code	60635876
Hospital Revenue Code	259
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

NAPROSYN/375MG/TAB

Facility

$6.00

Hospital Charge Code	60633494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

NAPROSYN/500MG/TAB

Facility

$6.00

Hospital Charge Code	60633496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

NAPROSYN/500MG/TAB

Facility

$6.00

Hospital Charge Code	60633495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

NAPROSYN/500MG/TAB

Facility

$6.00

Hospital Charge Code	60633495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges