Heights University Hospital

All Charges

Charge

Type

Setting

Price

Nylon cart cover to fit 1436-3

Facility

$425.00

Hospital Charge Code	270665975
Hospital Revenue Code	270
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

Nylon cart cover to fit 1436-3

Facility

$425.00

Hospital Charge Code	270665975
Hospital Revenue Code	270
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Oxford Commercial	$212.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$212.50

NYSTATIN 100000 U/ML UD

Facility

$8.44

Service Code	NDC 121478505
Hospital Charge Code	60628836
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$4.22
Rate for Payer: Aetna Commercial	$2.53
Rate for Payer: Aetna Medicare Advantage	$2.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.15
Rate for Payer: Cigna Commercial	$4.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.10
Rate for Payer: Oxford Commercial	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.27
Rate for Payer: UnitedHealthcare Commercial	$4.22

NYSTATIN 100000 U/ML UD

Facility

$8.44

Service Code	NDC 121478505
Hospital Charge Code	60628836
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.27

NYSTATIN 100000 UNT/GM OINT 15

Facility

$127.56

Hospital Charge Code	606350906
Hospital Revenue Code	250
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$19.13
Rate for Payer: Qualcare PPO/HMO/WC	$19.13

NYSTATIN 100000 UNT/GM OINT 15

Facility

$127.56

Hospital Charge Code	606350906
Hospital Revenue Code	250
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$63.78
Rate for Payer: Aetna Commercial	$38.27
Rate for Payer: Aetna Medicare Advantage	$38.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.53
Rate for Payer: Cigna Commercial	$63.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.58
Rate for Payer: Oxford Commercial	$63.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.13
Rate for Payer: UnitedHealthcare Commercial	$63.78

NYSTATIN/100KU/1ML

Facility

$42.00

Hospital Charge Code	60633564
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

NYSTATIN/100KU/1ML

Facility

$42.00

Hospital Charge Code	60633564
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$21.00

NYSTATIN 500,000U/5ML

Facility

$4.00

Hospital Charge Code	60635511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NYSTATIN 500,000U/5ML

Facility

$4.00

Hospital Charge Code	60635511
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

NYSTATIN 500000 UNITS TAB

Facility

$4.00

Hospital Charge Code	60627250
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

NYSTATIN 500000 UNITS TAB

Facility

$4.00

Hospital Charge Code	60627250
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NYSTATIN CRM TOP 100,000

Facility

$15.40

Hospital Charge Code	6010029
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

NYSTATIN CRM TOP 100,000

Facility

$15.40

Hospital Charge Code	6010029
Hospital Revenue Code	251
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

NYSTATIN/LIDO 1:1 MAGIC MIX 10

Facility

$600.00

Hospital Charge Code	60629928
Hospital Revenue Code	250
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$300.00

NYSTATIN/LIDO 1:1 MAGIC MIX 10

Facility

$600.00

Hospital Charge Code	60629928
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NYSTATIN LQ 100,000/1ML

Facility

$25.60

Hospital Charge Code	6009963
Hospital Revenue Code	251
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

NYSTATIN LQ 100,000/1ML

Facility

$25.60

Hospital Charge Code	6009963
Hospital Revenue Code	251
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

NYSTATIN OINT 100MU

Facility

$175.88

Service Code	NDC 472016630
Hospital Charge Code	60628343
Hospital Revenue Code	250
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$26.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.38

NYSTATIN OINT 100MU

Facility

$175.88

Service Code	NDC 472016630
Hospital Charge Code	60628343
Hospital Revenue Code	250
Min. Negotiated Rate	$22.86
Max. Negotiated Rate	$87.94
Rate for Payer: Aetna Commercial	$52.76
Rate for Payer: Aetna Medicare Advantage	$52.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.85
Rate for Payer: Cigna Commercial	$87.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.86
Rate for Payer: Oxford Commercial	$87.94
Rate for Payer: Qualcare PPO/HMO/WC	$26.38
Rate for Payer: UnitedHealthcare Commercial	$87.94

NYSTATIN OINT TOP 100,000

Facility

$15.40

Hospital Charge Code	6010011
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

NYSTATIN OINT TOP 100,000

Facility

$15.40

Hospital Charge Code	6010011
Hospital Revenue Code	251
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

NYSTATIN POWDER 60GM BOTTLE

Facility

$559.25

Service Code	NDC 16714076903
Hospital Charge Code	606390360
Hospital Revenue Code	250
Min. Negotiated Rate	$72.70
Max. Negotiated Rate	$279.62
Rate for Payer: Aetna Commercial	$167.78
Rate for Payer: Aetna Medicare Advantage	$167.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.61
Rate for Payer: Cigna Commercial	$279.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.70
Rate for Payer: Oxford Commercial	$279.62
Rate for Payer: Qualcare PPO/HMO/WC	$83.89
Rate for Payer: UnitedHealthcare Commercial	$279.62

NYSTATIN POWDER 60GM BOTTLE

Facility

$559.25

Service Code	NDC 16714076903
Hospital Charge Code	606390360
Hospital Revenue Code	250
Min. Negotiated Rate	$83.89
Max. Negotiated Rate	$83.89
Rate for Payer: Qualcare PPO/HMO/WC	$83.89

NYSTATIN POWD TOP 1000,000

Facility

$165.80

Hospital Charge Code	6009906
Hospital Revenue Code	251
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$82.90
Rate for Payer: Aetna Commercial	$49.74
Rate for Payer: Aetna Medicare Advantage	$49.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$82.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.55
Rate for Payer: Oxford Commercial	$82.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.87
Rate for Payer: UnitedHealthcare Commercial	$82.90

Know your out-of-pocket cost for care.

All Charges