Heights University Hospital

All Charges

Charge

Type

Setting

Price

TCU WHIRLPOOL

Facility

$78.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008160
Hospital Revenue Code	420
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

TCU WHIRLPOOL

Facility

$78.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008160
Hospital Revenue Code	420
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$686.00

TDAP (ADACEL) 0.5 ML VACCINE

Facility

$327.90

Service Code	HCPCS 90715
Hospital Charge Code	606350960
Hospital Revenue Code	636
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$98.37
Rate for Payer: Aetna Commercial	$98.37
Rate for Payer: Aetna Medicare Advantage	$98.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.61
Rate for Payer: Cigna Commercial	$39.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.19

TDAP (ADACEL) 0.5 ML VACCINE

Facility

$327.90

Service Code	HCPCS 90715
Hospital Charge Code	606350960
Hospital Revenue Code	636
Min. Negotiated Rate	$49.19
Max. Negotiated Rate	$79.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.19

TDAP (ADACEL) VACC EX

Facility

$327.09

Service Code	NDC 49281040020
Hospital Charge Code	606350960E
Hospital Revenue Code	259
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$163.54
Rate for Payer: Aetna Commercial	$98.13
Rate for Payer: Aetna Medicare Advantage	$98.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.41
Rate for Payer: Cigna Commercial	$163.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.52
Rate for Payer: Oxford Commercial	$163.54
Rate for Payer: Qualcare PPO/HMO/WC	$49.06
Rate for Payer: UnitedHealthcare Commercial	$163.54

TDAP (ADACEL) VACC EX

Facility

$327.09

Service Code	NDC 49281040020
Hospital Charge Code	606350960E
Hospital Revenue Code	259
Min. Negotiated Rate	$49.06
Max. Negotiated Rate	$49.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.06

TEAR DRO GUIDE WIRE

Facility

$845.00

Service Code	HCPCS C1769
Hospital Charge Code	270657835
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$253.50
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

TEAR DRO GUIDE WIRE

Facility

$845.00

Service Code	HCPCS C1769
Hospital Charge Code	270657835
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

TEARS NATURAL EYE FORTE

Facility

$57.89

Service Code	NDC 65042623
Hospital Charge Code	606351021
Hospital Revenue Code	250
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$17.37
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.53
Rate for Payer: Oxford Commercial	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$28.95

TEARS NATURAL EYE FORTE

Facility

$57.89

Service Code	NDC 65042623
Hospital Charge Code	606351021
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

TEARS NATURAL EYE FORTE

Facility

$62.02

Hospital Charge Code	606380013
Hospital Revenue Code	250
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$31.01
Rate for Payer: Aetna Commercial	$18.61
Rate for Payer: Aetna Medicare Advantage	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.82
Rate for Payer: Cigna Commercial	$31.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.06
Rate for Payer: Oxford Commercial	$31.01
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Commercial	$31.01

TEARS NATURAL EYE FORTE

Facility

$62.02

Hospital Charge Code	606380013
Hospital Revenue Code	250
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

TEDRAL/TAB

Facility

$3.00

Hospital Charge Code	60634399
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

TEDRAL/TAB

Facility

$3.00

Hospital Charge Code	60634399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEFLON BLOCK

Facility

$149.00

Hospital Charge Code	270335240
Hospital Revenue Code	272
Min. Negotiated Rate	$19.37
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$44.70
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.99
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.37
Rate for Payer: Oxford Commercial	$74.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$74.50

TEFLON BLOCK

Facility

$149.00

Hospital Charge Code	270335240
Hospital Revenue Code	272
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

TEFLON COATED GUIDE WIRE

Facility

$115.00

Hospital Charge Code	270330509
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

TEFLON COATED GUIDE WIRE

Facility

$115.00

Hospital Charge Code	270330509
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

TEFLON COATED STR. WIRE GUIDE

Facility

$211.00

Hospital Charge Code	270331705
Hospital Revenue Code	272
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$31.65
Rate for Payer: Qualcare PPO/HMO/WC	$31.65

TEFLON COATED STR. WIRE GUIDE

Facility

$211.00

Hospital Charge Code	270331705
Hospital Revenue Code	272
Min. Negotiated Rate	$27.43
Max. Negotiated Rate	$105.50
Rate for Payer: Aetna Commercial	$63.30
Rate for Payer: Aetna Medicare Advantage	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.80
Rate for Payer: Cigna Commercial	$105.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.43
Rate for Payer: Oxford Commercial	$105.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.65
Rate for Payer: UnitedHealthcare Commercial	$105.50

TEGADERM 4 X 4 3/4

Facility

$125.50

Hospital Charge Code	270655053
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$62.75
Rate for Payer: Aetna Commercial	$37.65
Rate for Payer: Aetna Medicare Advantage	$37.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.00
Rate for Payer: Cigna Commercial	$62.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.32
Rate for Payer: Oxford Commercial	$62.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$62.75

TEGADERM 4 X 4 3/4

Facility

$125.50

Hospital Charge Code	270655053
Hospital Revenue Code	270
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

TEGADERM FILM 3M 8X12

Facility

$8.89

Hospital Charge Code	270655592
Hospital Revenue Code	270
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

TEGADERM FILM 3M 8X12

Facility

$8.89

Hospital Charge Code	270655592
Hospital Revenue Code	270
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$4.45
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare Advantage	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.27
Rate for Payer: Cigna Commercial	$4.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Commercial	$4.45

TEGADERM HP OV 1 7/8 X 2 3/8

Facility

$4.85

Hospital Charge Code	270350206
Hospital Revenue Code	272
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

Know your out-of-pocket cost for care.

All Charges