Heights University Hospital

All Charges

Charge

Type

Setting

Price

TAGAMET/300MG/TAB

Facility

$3.00

Hospital Charge Code	60633959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TAGAMET/300MG/TAB

Facility

$3.00

Hospital Charge Code	60633953
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

TAGAMET/300MG/TAB

Facility

$4.00

Hospital Charge Code	60633961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TAGAMET/300MG/TAB

Facility

$3.00

Hospital Charge Code	60633953
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TAGAMET/300MG/TAB

Facility

$3.00

Hospital Charge Code	60633959
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

TAGAMET/300MG/TAB

Facility

$4.00

Hospital Charge Code	60633961
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

TAGAMET/400MG/TAB

Facility

$5.00

Hospital Charge Code	60633960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TAGAMET/400MG/TAB

Facility

$5.00

Hospital Charge Code	60633960
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

TAGAMET/400MG/TAB

Facility

$6.00

Hospital Charge Code	60633958
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TAGAMET/400MG/TAB

Facility

$6.00

Hospital Charge Code	60633958
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

TAGAMET/400MG/TAB

Facility

$7.00

Hospital Charge Code	60633952
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

TAGAMET/400MG/TAB

Facility

$7.00

Hospital Charge Code	60633952
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TAGAMET HB 200 M LIQ

Facility

$5.00

Hospital Charge Code	60635343
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TAGAMET HB 200 M LIQ

Facility

$5.00

Hospital Charge Code	60635343
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

TAKE DOWN SPLN FLXRE WP CLTMY

Facility

$2,513.20

Service Code	HCPCS 44139
Hospital Charge Code	1600000569
Hospital Revenue Code	360
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$753.96
Rate for Payer: Aetna Medicare Advantage	$753.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$640.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$640.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$640.87
Rate for Payer: Cigna Commercial	$115.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.72
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$376.98
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

TAKE DOWN SPLN FLXRE WP CLTMY

Facility

$2,513.20

Service Code	HCPCS 44139
Hospital Charge Code	1600000569
Hospital Revenue Code	360
Min. Negotiated Rate	$376.98
Max. Negotiated Rate	$376.98
Rate for Payer: Qualcare PPO/HMO/WC	$376.98

TALAR DOME FLAT CUT SZ 3

Facility

$69,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270704972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,371.58
Max. Negotiated Rate	$16,732.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,828.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,732.82
Rate for Payer: Qualcare PPO/HMO/WC	$10,371.58

TALAR DOME FLAT CUT SZ 3

Facility

$69,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270704972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,371.58
Max. Negotiated Rate	$34,571.95
Rate for Payer: Aetna Commercial	$20,743.17
Rate for Payer: Aetna Medicare Advantage	$20,743.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,631.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,631.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,828.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,631.69
Rate for Payer: Cigna Commercial	$34,571.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,732.82
Rate for Payer: Qualcare PPO/HMO/WC	$10,371.58

TALAR DOME SZ 1 SULCUS

Facility

$18,895.00

Service Code	HCPCS C1776
Hospital Charge Code	270670888
Hospital Revenue Code	278
Min. Negotiated Rate	$2,834.25
Max. Negotiated Rate	$9,447.50
Rate for Payer: Aetna Commercial	$5,668.50
Rate for Payer: Aetna Medicare Advantage	$5,668.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,818.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,818.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,818.23
Rate for Payer: Cigna Commercial	$9,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,572.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.25

TALAR DOME SZ 1 SULCUS

Facility

$18,895.00

Service Code	HCPCS C1776
Hospital Charge Code	270670888
Hospital Revenue Code	278
Min. Negotiated Rate	$2,834.25
Max. Negotiated Rate	$4,572.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,572.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.25

TALC 5 GM STERILE POWDER

Facility

$666.65

Service Code	NDC 63256020005
Hospital Charge Code	60628553
Hospital Revenue Code	250
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.00

TALC 5 GM STERILE POWDER

Facility

$666.65

Service Code	NDC 63256020005
Hospital Charge Code	60628553
Hospital Revenue Code	250
Min. Negotiated Rate	$86.66
Max. Negotiated Rate	$333.32
Rate for Payer: Aetna Commercial	$200.00
Rate for Payer: Aetna Medicare Advantage	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.00
Rate for Payer: Cigna Commercial	$333.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.66
Rate for Payer: Oxford Commercial	$333.32
Rate for Payer: Qualcare PPO/HMO/WC	$100.00
Rate for Payer: UnitedHealthcare Commercial	$333.32

TA LONG 90-3.5 STAPLER BLUE

Facility

$653.00

Hospital Charge Code	270334730
Hospital Revenue Code	272
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$97.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

TA LONG 90-3.5 STAPLER BLUE

Facility

$653.00

Hospital Charge Code	270334730
Hospital Revenue Code	272
Min. Negotiated Rate	$84.89
Max. Negotiated Rate	$326.50
Rate for Payer: Aetna Commercial	$195.90
Rate for Payer: Aetna Medicare Advantage	$195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.51
Rate for Payer: Cigna Commercial	$326.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.89
Rate for Payer: Oxford Commercial	$326.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.95
Rate for Payer: UnitedHealthcare Commercial	$326.50

TA LONG 90-4.8 STAPLER GREEN

Facility

$597.00

Hospital Charge Code	270334731
Hospital Revenue Code	272
Min. Negotiated Rate	$77.61
Max. Negotiated Rate	$298.50
Rate for Payer: Aetna Commercial	$179.10
Rate for Payer: Aetna Medicare Advantage	$179.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.24
Rate for Payer: Cigna Commercial	$298.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$298.50
Rate for Payer: Qualcare PPO/HMO/WC	$89.55
Rate for Payer: UnitedHealthcare Commercial	$298.50

Know your out-of-pocket cost for care.

All Charges