Heights University Hospital

All Charges

Charge

Type

Setting

Price

TEGRETOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60633975
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEGRETOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633973
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

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633972
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

TEGRETOL/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633971
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/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633972
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEGRETOL/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633971
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TEGRETOL CITRUS-VANILLA

Facility

$4.00

Service Code	NDC 60432012916
Hospital Charge Code	60633976
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 CITRUS-VANILLA

Facility

$4.00

Service Code	NDC 60432012916
Hospital Charge Code	60633976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TEGRETOL XR 100 BULK

Facility

$7.44

Service Code	NDC 78051005
Hospital Charge Code	60635257
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Oxford Commercial	$3.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.72

TEGRETOL XR 100 BULK

Facility

$7.44

Service Code	NDC 78051005
Hospital Charge Code	60635257
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

TEGRETOL XR 200 U/D

Facility

$13.94

Service Code	NDC 51672412401
Hospital Charge Code	60635258
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$6.97
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.55
Rate for Payer: Cigna Commercial	$6.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.09
Rate for Payer: UnitedHealthcare Commercial	$6.97

TEGRETOL XR 200 U/D

Facility

$13.94

Service Code	NDC 51672412401
Hospital Charge Code	60635258
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

TEGRETOL XR 400MG

Facility

$7.00

Hospital Charge Code	60635137
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

TEGRETOL XR 400MG

Facility

$7.00

Hospital Charge Code	60635137
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TEGRETOL XR 400 U/D

Facility

$6.00

Hospital Charge Code	60635259
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

TEGRETOL XR 400 U/D

Facility

$6.00

Hospital Charge Code	60635259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TEICHOIC ACID AB

Facility

$131.25

Service Code	HCPCS 86329
Hospital Charge Code	3006749
Hospital Revenue Code	302
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

TEICHOIC ACID AB

Facility

$131.25

Service Code	HCPCS 86329
Hospital Charge Code	3006749
Hospital Revenue Code	302
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.52
Rate for Payer: Aetna Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.48
Rate for Payer: Cigna Commercial	$14.05
Rate for Payer: Cigna Medicare Advantage	$7.03
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.89
Rate for Payer: Wellcare Medicare Advantage	$14.05

TEICHOIC ACID AB

Facility

$82.35

Service Code	HCPCS 86331
Hospital Charge Code	39900213
Hospital Revenue Code	302
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

TEICHOIC ACID AB

Facility

$82.35

Service Code	HCPCS 86331
Hospital Charge Code	39900213
Hospital Revenue Code	302
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$12.35
Rate for Payer: Qualcare PPO/HMO/WC	$12.35

TEICHOIC ACID ANTIBODIES

Facility

$293.00

Service Code	HCPCS 86331
Hospital Charge Code	38472613
Hospital Revenue Code	302
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

TEICHOIC ACID ANTIBODIES

Facility

$293.00

Service Code	HCPCS 86331
Hospital Charge Code	38472613
Hospital Revenue Code	302
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

TEICHOIC ACID TITER

Facility

$96.50

Service Code	HCPCS 86329
Hospital Charge Code	39900212
Hospital Revenue Code	302
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.52
Rate for Payer: Aetna Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.48
Rate for Payer: Cigna Commercial	$14.05
Rate for Payer: Cigna Medicare Advantage	$7.03
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.47
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.89
Rate for Payer: Wellcare Medicare Advantage	$14.05

Know your out-of-pocket cost for care.

All Charges