Heights University Hospital

All Charges

Charge

Type

Setting

Price

TEQUIN 400MG/200ML PREMIX

Facility

$107.00

Hospital Charge Code	60635339
Hospital Revenue Code	250
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$32.10
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$53.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$53.50

TEQUIN 400MG/200ML PREMIX

Facility

$107.00

Hospital Charge Code	60635339
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

TEQUIN 400 MG INJ 40 ML

Facility

$135.00

Hospital Charge Code	60635287
Hospital Revenue Code	636
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

TEQUIN 400 MG INJ 40 ML

Facility

$135.00

Hospital Charge Code	60635287
Hospital Revenue Code	636
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

TEQUIN 400 MG TAB

Facility

$28.00

Hospital Charge Code	60635286
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

TEQUIN 400 MG TAB

Facility

$28.00

Hospital Charge Code	60635286
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

TERAZOSIN 1 MG CAP

Facility

$10.79

Service Code	NDC 51079093601
Hospital Charge Code	6027106
Hospital Revenue Code	251
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna Commercial	$3.24
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$5.39

TERAZOSIN 1 MG CAP

Facility

$10.79

Service Code	NDC 51079093601
Hospital Charge Code	6027106
Hospital Revenue Code	251
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

TERAZOSIN 5 MG CAP

Facility

$10.79

Service Code	NDC 51079093820
Hospital Charge Code	6027098
Hospital Revenue Code	251
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

TERAZOSIN 5 MG CAP

Facility

$10.79

Service Code	NDC 51079093820
Hospital Charge Code	6027098
Hospital Revenue Code	251
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna Commercial	$3.24
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$5.39

TERBINAFINE 250 MG TAB

Facility

$49.65

Hospital Charge Code	60628767
Hospital Revenue Code	250
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$7.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.45

TERBINAFINE 250 MG TAB

Facility

$49.65

Hospital Charge Code	60628767
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$24.82
Rate for Payer: Aetna Commercial	$14.89
Rate for Payer: Aetna Medicare Advantage	$14.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.66
Rate for Payer: Cigna Commercial	$24.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Oxford Commercial	$24.82
Rate for Payer: Qualcare PPO/HMO/WC	$7.45
Rate for Payer: UnitedHealthcare Commercial	$24.82

TERBUTALINE 1 MG/ML INJ

Facility

$150.68

Service Code	HCPCS J3105
Hospital Charge Code	60627471
Hospital Revenue Code	636
Min. Negotiated Rate	$22.60
Max. Negotiated Rate	$36.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.46
Rate for Payer: Qualcare PPO/HMO/WC	$22.60

TERBUTALINE 1 MG/ML INJ

Facility

$150.68

Service Code	HCPCS J3105
Hospital Charge Code	60627471
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$45.20
Rate for Payer: Aetna Commercial	$45.20
Rate for Payer: Aetna Medicare Advantage	$45.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.42
Rate for Payer: Cigna Commercial	$2.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.46
Rate for Payer: Qualcare PPO/HMO/WC	$22.60

TERBUTALINE 2.5 MG TAB

Facility

$36.45

Service Code	NDC 115261101
Hospital Charge Code	60627472
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

TERBUTALINE 2.5 MG TAB

Facility

$36.45

Service Code	NDC 115261101
Hospital Charge Code	60627472
Hospital Revenue Code	250
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$18.23

TERBUTALINE INJ 1MG

Facility

$15.40

Hospital Charge Code	6009070
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

TERBUTALINE INJ 1MG

Facility

$15.40

Hospital Charge Code	6009070
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

TERBUTALINE ORL INH 0.2MG

Facility

$185.00

Hospital Charge Code	60627470
Hospital Revenue Code	250
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

TERBUTALINE ORL INH 0.2MG

Facility

$185.00

Hospital Charge Code	60627470
Hospital Revenue Code	250
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

TERCONAZOLE 0.4% VAG CREAM 45G

Facility

$274.23

Service Code	NDC 591319689
Hospital Charge Code	6063943314
Hospital Revenue Code	250
Min. Negotiated Rate	$35.65
Max. Negotiated Rate	$137.12
Rate for Payer: Aetna Commercial	$82.27
Rate for Payer: Aetna Medicare Advantage	$82.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.93
Rate for Payer: Cigna Commercial	$137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.65
Rate for Payer: Oxford Commercial	$137.12
Rate for Payer: Qualcare PPO/HMO/WC	$41.13
Rate for Payer: UnitedHealthcare Commercial	$137.12

TERCONAZOLE 0.4% VAG CREAM 45G

Facility

$274.23

Service Code	NDC 591319689
Hospital Charge Code	6063943314
Hospital Revenue Code	250
Min. Negotiated Rate	$41.13
Max. Negotiated Rate	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$41.13

TERCONAZOLE 0.8% VAG CRM 20GM

Facility

$436.17

Service Code	NDC 50458053601
Hospital Charge Code	606361042
Hospital Revenue Code	250
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$218.09
Rate for Payer: Aetna Commercial	$130.85
Rate for Payer: Aetna Medicare Advantage	$130.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.22
Rate for Payer: Cigna Commercial	$218.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.70
Rate for Payer: Oxford Commercial	$218.09
Rate for Payer: Qualcare PPO/HMO/WC	$65.43
Rate for Payer: UnitedHealthcare Commercial	$218.09

TERCONAZOLE 0.8% VAG CRM 20GM

Facility

$436.17

Service Code	NDC 50458053601
Hospital Charge Code	606361042
Hospital Revenue Code	250
Min. Negotiated Rate	$65.43
Max. Negotiated Rate	$65.43
Rate for Payer: Qualcare PPO/HMO/WC	$65.43

TERIPARATIDE 750MCG/3ML

Facility

$3,804.50

Hospital Charge Code	60629880
Hospital Revenue Code	250
Min. Negotiated Rate	$494.58
Max. Negotiated Rate	$1,902.25
Rate for Payer: Aetna Commercial	$1,141.35
Rate for Payer: Aetna Medicare Advantage	$1,141.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$970.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$970.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$970.15
Rate for Payer: Cigna Commercial	$1,902.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$494.58
Rate for Payer: Oxford Commercial	$1,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$570.67
Rate for Payer: UnitedHealthcare Commercial	$1,902.25

Know your out-of-pocket cost for care.

All Charges