Heights University Hospital

All Charges

Charge

Type

Setting

Price

NITRO-BID 2% OINT 30GM TB

Facility

$49.00

Hospital Charge Code	60635683
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

NITRO-BID 2% OINT 30GM TB

Facility

$49.00

Hospital Charge Code	60635683
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

NITROBID U/D

Facility

$3.00

Hospital Charge Code	60634962
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

NITROBID U/D

Facility

$3.00

Hospital Charge Code	60634962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITRO-DUR 0.8 MG/HR

Facility

$13.00

Hospital Charge Code	60635230
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

NITRO-DUR 0.8 MG/HR

Facility

$13.00

Hospital Charge Code	60635230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

NITRODUR PATCH/0.1MG/HR

Facility

$5.00

Hospital Charge Code	60634507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
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	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

NITRODUR PATCH/0.1MG/HR

Facility

$5.00

Hospital Charge Code	60634507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.2MG/HR

Facility

$5.00

Hospital Charge Code	60634508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.2MG/HR

Facility

$5.00

Hospital Charge Code	60634508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
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	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

NITRODUR PATCH/0.3MG/HR

Facility

$5.00

Hospital Charge Code	60634509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.3MG/HR

Facility

$5.00

Hospital Charge Code	60634509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
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	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

NITRODUR PATCH/0.4MG/HR

Facility

$5.00

Hospital Charge Code	60634510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
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	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

NITRODUR PATCH/0.4MG/HR

Facility

$5.00

Hospital Charge Code	60634510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH/0.6MG/HR

Facility

$5.00

Hospital Charge Code	60634511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
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	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

NITRODUR PATCH/0.6MG/HR

Facility

$5.00

Hospital Charge Code	60634511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

NITRODUR PATCH .2MG/1HR

Facility

$17.42

Service Code	NDC 47781029703
Hospital Charge Code	6006613
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.61

NITRODUR PATCH .2MG/1HR

Facility

$17.42

Service Code	NDC 47781029703
Hospital Charge Code	6006613
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$8.71
Rate for Payer: Aetna Commercial	$5.23
Rate for Payer: Aetna Medicare Advantage	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.44
Rate for Payer: Cigna Commercial	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.26
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.61
Rate for Payer: UnitedHealthcare Commercial	$8.71

NITROFURANTOIN 25MG/5ML SUSP

Facility

$106.40

Service Code	NDC 66993047173
Hospital Charge Code	6063943149
Hospital Revenue Code	250
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$53.20
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$31.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.13
Rate for Payer: Cigna Commercial	$53.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.83
Rate for Payer: Oxford Commercial	$53.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.96
Rate for Payer: UnitedHealthcare Commercial	$53.20

NITROFURANTOIN 25MG/5ML SUSP

Facility

$106.40

Service Code	NDC 66993047173
Hospital Charge Code	6063943149
Hospital Revenue Code	250
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$15.96
Rate for Payer: Qualcare PPO/HMO/WC	$15.96

NITROFURANTOIN NITROF CAP100MG

Facility

$114.70

Service Code	NDC 52427028501
Hospital Charge Code	60627353
Hospital Revenue Code	251
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.20

NITROFURANTOIN NITROF CAP100MG

Facility

$114.70

Service Code	NDC 52427028501
Hospital Charge Code	60627353
Hospital Revenue Code	251
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$57.35
Rate for Payer: Aetna Commercial	$34.41
Rate for Payer: Aetna Medicare Advantage	$34.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.25
Rate for Payer: Cigna Commercial	$57.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.91
Rate for Payer: Oxford Commercial	$57.35
Rate for Payer: Qualcare PPO/HMO/WC	$17.20
Rate for Payer: UnitedHealthcare Commercial	$57.35

NITROFURAZONE CRM 0.2%

Facility

$142.75

Hospital Charge Code	60628352
Hospital Revenue Code	250
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$42.83
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.56
Rate for Payer: Oxford Commercial	$71.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$71.38

NITROFURAZONE CRM 0.2%

Facility

$142.75

Hospital Charge Code	60628352
Hospital Revenue Code	250
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

NITROFURAZONE TOP .2% 56GM

Facility

$122.25

Hospital Charge Code	6003941
Hospital Revenue Code	252
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$36.67
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Oxford Commercial	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$61.12

Know your out-of-pocket cost for care.

All Charges