Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

NYSTATIN SSP 500,000U/5ML

Facility

$3.85

Hospital Charge Code	6025084
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

NYSTATIN SSP 500,000U/5ML

Facility

$3.85

Hospital Charge Code	6025084
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

NYSTATIN SSP UD 100000U/ML 5ML

Facility

$3.20

Hospital Charge Code	60627248
Hospital Revenue Code	251
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

NYSTATIN SSP UD 100000U/ML 5ML

Facility

$3.20

Hospital Charge Code	60627248
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

NYSTATIN TAB VAG 100MU

Facility

$110.45

Hospital Charge Code	60628344
Hospital Revenue Code	250
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$55.23
Rate for Payer: Aetna Commercial	$33.13
Rate for Payer: Aetna Medicare Advantage	$33.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.16
Rate for Payer: Cigna Commercial	$55.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.36
Rate for Payer: Oxford Commercial	$55.23
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$55.23

NYSTATIN TAB VAG 100MU

Facility

$110.45

Hospital Charge Code	60628344
Hospital Revenue Code	250
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

NYSTATIN TOPICAL CREAM

Facility

$117.59

Service Code	NDC 51672128901
Hospital Charge Code	60628342
Hospital Revenue Code	250
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$58.80
Rate for Payer: Aetna Commercial	$35.28
Rate for Payer: Aetna Medicare Advantage	$35.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.99
Rate for Payer: Cigna Commercial	$58.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.29
Rate for Payer: Oxford Commercial	$58.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.64
Rate for Payer: UnitedHealthcare Commercial	$58.80

NYSTATIN TOPICAL CREAM

Facility

$117.59

Service Code	NDC 51672128901
Hospital Charge Code	60628342
Hospital Revenue Code	250
Min. Negotiated Rate	$17.64
Max. Negotiated Rate	$17.64
Rate for Payer: Qualcare PPO/HMO/WC	$17.64

NYSTATIN TRIAMCIN CRM 30GM

Facility

$147.07

Service Code	NDC 75907006044
Hospital Charge Code	6007223
Hospital Revenue Code	251
Min. Negotiated Rate	$22.06
Max. Negotiated Rate	$22.06
Rate for Payer: Qualcare PPO/HMO/WC	$22.06

NYSTATIN TRIAMCIN CRM 30GM

Facility

$147.07

Service Code	NDC 75907006044
Hospital Charge Code	6007223
Hospital Revenue Code	251
Min. Negotiated Rate	$19.12
Max. Negotiated Rate	$73.53
Rate for Payer: Aetna Commercial	$44.12
Rate for Payer: Aetna Medicare Advantage	$44.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.50
Rate for Payer: Cigna Commercial	$73.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Oxford Commercial	$73.53
Rate for Payer: Qualcare PPO/HMO/WC	$22.06
Rate for Payer: UnitedHealthcare Commercial	$73.53

NYSTATIN/TRIAMCINOLONE OINTMNT

Facility

$750.00

Service Code	NDC 168008115
Hospital Charge Code	60632330
Hospital Revenue Code	250
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

NYSTATIN/TRIAMCINOLONE OINTMNT

Facility

$750.00

Service Code	NDC 168008115
Hospital Charge Code	60632330
Hospital Revenue Code	250
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$375.00

NYSTATIN W/TRIAMCINOLONE

Facility

$750.00

Service Code	NDC 51672127201
Hospital Charge Code	60633566
Hospital Revenue Code	250
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

NYSTATIN W/TRIAMCINOLONE

Facility

$750.00

Service Code	NDC 51672127201
Hospital Charge Code	60633566
Hospital Revenue Code	250
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$375.00

O2 CANN CONT INIT AD W/CAN***

Facility

$63.00

Service Code	HCPCS A4615
Hospital Charge Code	9500365
Hospital Revenue Code	279
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$1.04
Rate for Payer: Cigna Medicare Advantage	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.19
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$31.50

O2 CANN CONT INIT AD W/CAN***

Facility

$63.00

Service Code	HCPCS A4615
Hospital Charge Code	9500365
Hospital Revenue Code	279
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

O2 CANN CONT INIT PED W/CANN**

Facility

$65.00

Service Code	HCPCS A4615
Hospital Charge Code	9500366
Hospital Revenue Code	279
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

O2 CANN CONT INIT PED W/CANN**

Facility

$65.00

Service Code	HCPCS A4615
Hospital Charge Code	9500366
Hospital Revenue Code	279
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$1.04
Rate for Payer: Cigna Medicare Advantage	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$32.50

O2 CANNULA CONTINOUS SUBSEQ***

Facility

$33.00

Service Code	HCPCS A4615
Hospital Charge Code	9500367
Hospital Revenue Code	279
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

O2 CANNULA CONTINOUS SUBSEQ***

Facility

$33.00

Service Code	HCPCS A4615
Hospital Charge Code	9500367
Hospital Revenue Code	279
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$1.04
Rate for Payer: Cigna Medicare Advantage	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

O2 CANNULA CONTINUOUS

Facility

$106.00

Service Code	HCPCS A4615
Hospital Charge Code	9500364
Hospital Revenue Code	279
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

O2 CANNULA CONTINUOUS

Facility

$106.00

Service Code	HCPCS A4615
Hospital Charge Code	9500364
Hospital Revenue Code	279
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$1.04
Rate for Payer: Cigna Medicare Advantage	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$53.00

O2 CANNULA PRN***

Facility

$33.00

Hospital Charge Code	9500372
Hospital Revenue Code	279
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

O2 CANNULA PRN***

Facility

$33.00

Hospital Charge Code	9500372
Hospital Revenue Code	279
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

Know your out-of-pocket cost for care.

All Charges