Heights University Hospital

All Charges

Charge

Type

Setting

Price

TETANUS ANTITOXOID AB

Facility

$128.00

Service Code	HCPCS 86317
Hospital Charge Code	3035056
Hospital Revenue Code	300
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TETANUS ANTITOXOID AB

Facility

$390.00

Service Code	HCPCS 86774
Hospital Charge Code	39900254
Hospital Revenue Code	302
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.23
Rate for Payer: Cigna Commercial	$14.80
Rate for Payer: Cigna Medicare Advantage	$7.40
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.69
Rate for Payer: Wellcare Medicare Advantage	$14.80

TETANUS ANTITOXOID AB

Facility

$128.00

Service Code	HCPCS 86317
Hospital Charge Code	3035056
Hospital Revenue Code	300
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.57
Rate for Payer: Aetna Medicare Advantage	$14.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.92
Rate for Payer: Cigna Commercial	$14.99
Rate for Payer: Cigna Medicare Advantage	$7.50
Rate for Payer: Clover Medicare Advantage	$14.24
Rate for Payer: EmblemHealth Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.89
Rate for Payer: Wellcare Medicare Advantage	$14.99

TETANUS ANTITOXOID AB

Facility

$390.00

Service Code	HCPCS 86774
Hospital Charge Code	39900254
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TETANUS DIPHTHERIA ADULT INJ

Facility

$115.45

Service Code	HCPCS 90714
Hospital Charge Code	60628299
Hospital Revenue Code	636
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$38.75
Rate for Payer: Aetna Commercial	$34.63
Rate for Payer: Aetna Medicare Advantage	$34.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.44
Rate for Payer: Cigna Commercial	$38.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

TETANUS DIPHTHERIA ADULT INJ

Facility

$115.45

Service Code	HCPCS 90714
Hospital Charge Code	60628299
Hospital Revenue Code	636
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$27.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

TETANUS,DIPH TOXOID ADULT

Facility

$18.00

Hospital Charge Code	60633995
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

TETANUS,DIPH TOXOID ADULT

Facility

$18.00

Hospital Charge Code	60633995
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TETANUS DIPTH ADULT

Facility

$10.90

Hospital Charge Code	6006399
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

TETANUS DIPTH ADULT

Facility

$10.90

Hospital Charge Code	6006399
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

TETANUS DIPTH PEDS

Facility

$82.60

Hospital Charge Code	6006407
Hospital Revenue Code	250
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

TETANUS DIPTH PEDS

Facility

$82.60

Hospital Charge Code	6006407
Hospital Revenue Code	250
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.74
Rate for Payer: Oxford Commercial	$41.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$41.30

TETANUS IMM GLOB VACC EX

Facility

$844.20

Service Code	NDC 13533063402
Hospital Charge Code	60628311EX
Hospital Revenue Code	259
Min. Negotiated Rate	$109.75
Max. Negotiated Rate	$422.10
Rate for Payer: Aetna Commercial	$253.26
Rate for Payer: Aetna Medicare Advantage	$253.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.27
Rate for Payer: Cigna Commercial	$422.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.75
Rate for Payer: Oxford Commercial	$422.10
Rate for Payer: Qualcare PPO/HMO/WC	$126.63
Rate for Payer: UnitedHealthcare Commercial	$422.10

TETANUS IMM GLOB VACC EX

Facility

$844.20

Service Code	NDC 13533063402
Hospital Charge Code	60628311EX
Hospital Revenue Code	259
Min. Negotiated Rate	$126.63
Max. Negotiated Rate	$126.63
Rate for Payer: Qualcare PPO/HMO/WC	$126.63

TETANUS IMMUNE GLOB 250 U

Facility

$90.00

Hospital Charge Code	60633141
Hospital Revenue Code	636
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

TETANUS IMMUNE GLOB 250 U

Facility

$90.00

Hospital Charge Code	60633141
Hospital Revenue Code	636
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

TETANUS IMMUNE GLOB INJ 250U

Facility

$115.85

Hospital Charge Code	6009088
Hospital Revenue Code	636
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$57.92
Rate for Payer: Aetna Commercial	$34.76
Rate for Payer: Aetna Medicare Advantage	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.54
Rate for Payer: Cigna Commercial	$57.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Qualcare PPO/HMO/WC	$17.38

TETANUS IMMUNE GLOB INJ 250U

Facility

$115.85

Hospital Charge Code	6009088
Hospital Revenue Code	636
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$28.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Qualcare PPO/HMO/WC	$17.38

TETANUS IMMUNE GLOB INJ 250U

Facility

$142.75

Hospital Charge Code	6005193
Hospital Revenue Code	636
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$42.83
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

TETANUS IMMUNE GLOB INJ 250U

Facility

$142.75

Hospital Charge Code	6005193
Hospital Revenue Code	636
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$34.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

TETANUS TOXOID ADSORBED A

Facility

$18.00

Hospital Charge Code	60633992
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

TETANUS TOXOID ADSORBED A

Facility

$18.00

Hospital Charge Code	60633993
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TETANUS TOXOID ADSORBED A

Facility

$18.00

Hospital Charge Code	60633992
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TETANUS TOXOID ADSORBED A

Facility

$18.00

Hospital Charge Code	60633993
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

TETANUS TOXOID FLUID/0.5M

Facility

$18.00

Hospital Charge Code	60633994
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

Know your out-of-pocket cost for care.

All Charges