Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$4.85

Hospital Charge Code	270350206
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TEGADERM HP OV 3 1/2 X 4******

Facility

$5.00

Hospital Charge Code	8003733
Hospital Revenue Code	272
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

TEGADERM HP OV 3 1/2 X 4******

Facility

$5.00

Hospital Charge Code	8003733
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TEGADERM HP OV 3 1/2X4

Facility

$12.85

Hospital Charge Code	270350207
Hospital Revenue Code	272
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$6.42

TEGADERM HP OV 3 1/2X4

Facility

$12.85

Hospital Charge Code	270350207
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

TEGADERM HP OV 5 1/2 X 7*****

Facility

$12.00

Hospital Charge Code	8003741
Hospital Revenue Code	272
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

TEGADERM HP OV 5 1/2 X 7*****

Facility

$12.00

Hospital Charge Code	8003741
Hospital Revenue Code	272
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

TEGADERM OCCLUSIVE 4 X 6

Facility

$125.05

Hospital Charge Code	270649961
Hospital Revenue Code	272
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$62.52
Rate for Payer: Aetna Commercial	$37.52
Rate for Payer: Aetna Medicare Advantage	$37.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.89
Rate for Payer: Cigna Commercial	$62.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.26
Rate for Payer: Oxford Commercial	$62.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.76
Rate for Payer: UnitedHealthcare Commercial	$62.52

TEGADERM OCCLUSIVE 4 X 6

Facility

$125.05

Hospital Charge Code	270649961
Hospital Revenue Code	272
Min. Negotiated Rate	$18.76
Max. Negotiated Rate	$18.76
Rate for Payer: Qualcare PPO/HMO/WC	$18.76

TEGADERM TRANSP 6X8

Facility

$6.04

Hospital Charge Code	270650240S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Oxford Commercial	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$3.02

TEGADERM TRANSP 6X8

Facility

$6.04

Hospital Charge Code	270650240S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

TEGADERM TRANSPAREMT 4X4 1626W

Facility

$3.09

Hospital Charge Code	270649122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.46

TEGADERM TRANSPAREMT 4X4 1626W

Facility

$3.09

Hospital Charge Code	270649122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.79
Rate for Payer: Cigna Commercial	$1.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.40
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$0.46
Rate for Payer: UnitedHealthcare Commercial	$1.54

TEGADERM TRANSPARENT 8X12

Facility

$9.75

Hospital Charge Code	270649123
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

TEGADERM TRANSPARENT 8X12

Facility

$9.75

Hospital Charge Code	270649123
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$4.88
Rate for Payer: Aetna Commercial	$2.92
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$4.88

TEGASEROD 2 MG TAB UD

Facility

$18.75

Hospital Charge Code	60629849
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.81

TEGASEROD 2 MG TAB UD

Facility

$18.75

Hospital Charge Code	60629849
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$9.38
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: Aetna Medicare Advantage	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.78
Rate for Payer: Cigna Commercial	$9.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.44
Rate for Payer: Oxford Commercial	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$9.38

TEGASEROD 6 MG TAB

Facility

$12.85

Hospital Charge Code	60629262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

TEGASEROD 6 MG TAB

Facility

$12.85

Hospital Charge Code	60629262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$6.42

TEGASORB 2 3/4 X 3 1/2

Facility

$32.00

Hospital Charge Code	270350217
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

TEGASORB 2 3/4 X 3 1/2

Facility

$32.00

Hospital Charge Code	270350217
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

TEGASORB 4 X 4 3/4

Facility

$44.85

Hospital Charge Code	270350218
Hospital Revenue Code	272
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$22.43
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.44
Rate for Payer: Cigna Commercial	$22.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.83
Rate for Payer: Oxford Commercial	$22.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.73
Rate for Payer: UnitedHealthcare Commercial	$22.43

TEGASORB 4 X 4 3/4

Facility

$44.85

Hospital Charge Code	270350218
Hospital Revenue Code	272
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.73

TEGRETOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633974
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

TEGRETOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60633975
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

Know your out-of-pocket cost for care.

All Charges