Heights University Hospital

All Charges

Charge

Type

Setting

Price

NITROFURAZONE TOP .2% 56GM

Facility

$122.25

Hospital Charge Code	6003941
Hospital Revenue Code	252
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

NITROGEN K CYLINGER

Facility

$37.25

Hospital Charge Code	270658091
Hospital Revenue Code	270
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$5.59

NITROGEN K CYLINGER

Facility

$37.25

Hospital Charge Code	270658091
Hospital Revenue Code	270
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$18.62
Rate for Payer: Aetna Commercial	$11.18
Rate for Payer: Aetna Medicare Advantage	$11.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.50
Rate for Payer: Cigna Commercial	$18.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.84
Rate for Payer: Oxford Commercial	$18.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.59
Rate for Payer: UnitedHealthcare Commercial	$18.62

NITROGEN K TANK 230 C.T. PRE

Facility

$39.85

Hospital Charge Code	270658090
Hospital Revenue Code	270
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$19.93
Rate for Payer: Aetna Commercial	$11.96
Rate for Payer: Aetna Medicare Advantage	$11.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.16
Rate for Payer: Cigna Commercial	$19.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Oxford Commercial	$19.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.98
Rate for Payer: UnitedHealthcare Commercial	$19.93

NITROGEN K TANK 230 C.T. PRE

Facility

$39.85

Hospital Charge Code	270658090
Hospital Revenue Code	270
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$5.98
Rate for Payer: Qualcare PPO/HMO/WC	$5.98

NITROGEN K TANK 230 CU FT

Facility

$61.05

Hospital Charge Code	270653906
Hospital Revenue Code	272
Min. Negotiated Rate	$7.94
Max. Negotiated Rate	$30.52
Rate for Payer: Aetna Commercial	$18.32
Rate for Payer: Aetna Medicare Advantage	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.57
Rate for Payer: Cigna Commercial	$30.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.94
Rate for Payer: Oxford Commercial	$30.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.16
Rate for Payer: UnitedHealthcare Commercial	$30.52

NITROGEN K TANK 230 CU FT

Facility

$61.05

Hospital Charge Code	270653906
Hospital Revenue Code	272
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$9.16
Rate for Payer: Qualcare PPO/HMO/WC	$9.16

NITROGLYCERIN 0.4 MG TAB

Facility

$4.00

Service Code	NDC 71041813
Hospital Charge Code	6013049
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NITROGLYCERIN 0.4 MG TAB

Facility

$4.00

Service Code	NDC 71041813
Hospital Charge Code	6013049
Hospital Revenue Code	251
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

NITROGLYCERIN 2%/30GM

Facility

$15.00

Hospital Charge Code	60633536
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

NITROGLYCERIN 2%/30GM

Facility

$15.00

Hospital Charge Code	60633536
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633530
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

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633534
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

NITROGLYCERIN/2.5MG/CAP

Facility

$3.00

Hospital Charge Code	60633534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NITROGLYCERIN 2.5 MG ER CAP

Facility

$4.62

Service Code	NDC 904064360
Hospital Charge Code	60627658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

NITROGLYCERIN 2.5 MG ER CAP

Facility

$4.62

Service Code	NDC 904064360
Hospital Charge Code	60627658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.39
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$2.31

NITROGLYCERIN 2% OINTMENT UD

Facility

$20.30

Service Code	NDC 281032608
Hospital Charge Code	60627657
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$10.15
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: Aetna Medicare Advantage	$6.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.18
Rate for Payer: Cigna Commercial	$10.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.64
Rate for Payer: Oxford Commercial	$10.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.04
Rate for Payer: UnitedHealthcare Commercial	$10.15

NITROGLYCERIN 2% OINTMENT UD

Facility

$20.30

Service Code	NDC 281032608
Hospital Charge Code	60627657
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.04

NITROGLYCERIN 2% OINTMENT UD

Facility

$12.55

Hospital Charge Code	60627657R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

NITROGLYCERIN 2% OINTMENT UD

Facility

$12.55

Hospital Charge Code	60627657R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna Medicare Advantage	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.63
Rate for Payer: Oxford Commercial	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$6.28

NITROGLYCERIN 50MG/10ML INJ

Facility

$108.88

Service Code	NDC 517481025
Hospital Charge Code	6003958
Hospital Revenue Code	250
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$54.44
Rate for Payer: Aetna Commercial	$32.66
Rate for Payer: Aetna Medicare Advantage	$32.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.76
Rate for Payer: Cigna Commercial	$54.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.15
Rate for Payer: Oxford Commercial	$54.44
Rate for Payer: Qualcare PPO/HMO/WC	$16.33
Rate for Payer: UnitedHealthcare Commercial	$54.44

NITROGLYCERIN 50MG/10ML INJ

Facility

$108.88

Service Code	NDC 517481025
Hospital Charge Code	6003958
Hospital Revenue Code	250
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.33

NITROGLYCERIN/50MG/250D5W

Facility

$27.00

Hospital Charge Code	60634989
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

NITROGLYCERIN/50MG/250D5W

Facility

$27.00

Hospital Charge Code	60634989
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$13.50

Know your out-of-pocket cost for care.

All Charges