Heights University Hospital

All Charges

Charge

Type

Setting

Price

TETRACYCLINE 250 MG CAP

Facility

$4.00

Service Code	NDC 172241660
Hospital Charge Code	60627319
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TETRACYCLINE 250 MG CAP

Facility

$4.00

Service Code	NDC 172241660
Hospital Charge Code	60627319
Hospital Revenue Code	251
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

TETRACYCLINE/250MG/CAP

Facility

$4.00

Hospital Charge Code	60633998
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

TETRACYCLINE/250MG/CAP

Facility

$4.00

Hospital Charge Code	60633998
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TETRACYCLINE OINT 3% 28GM

Facility

$95.40

Hospital Charge Code	6005243
Hospital Revenue Code	251
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

TETRACYCLINE OINT 3% 28GM

Facility

$95.40

Hospital Charge Code	6005243
Hospital Revenue Code	251
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.40
Rate for Payer: Oxford Commercial	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.31
Rate for Payer: UnitedHealthcare Commercial	$47.70

TETRACYCLINE OINT OPH 1% 3.5GM

Facility

$95.40

Hospital Charge Code	6005250
Hospital Revenue Code	251
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

TETRACYCLINE OINT OPH 1% 3.5GM

Facility

$95.40

Hospital Charge Code	6005250
Hospital Revenue Code	251
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.40
Rate for Payer: Oxford Commercial	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.31
Rate for Payer: UnitedHealthcare Commercial	$47.70

TETRAHYDROZOLN OPH .05% 15ML

Facility

$23.70

Hospital Charge Code	6005268
Hospital Revenue Code	251
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

TETRAHYDROZOLN OPH .05% 15ML

Facility

$23.70

Hospital Charge Code	6005268
Hospital Revenue Code	251
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$11.85
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: Aetna Medicare Advantage	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.04
Rate for Payer: Cigna Commercial	$11.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.08
Rate for Payer: Oxford Commercial	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$3.56
Rate for Payer: UnitedHealthcare Commercial	$11.85

TETRAHYDROZOLN OPH SOL 0.05%

Facility

$28.14

Service Code	NDC 74300000803
Hospital Charge Code	60628082
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$8.44
Rate for Payer: Aetna Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.22
Rate for Payer: UnitedHealthcare Commercial	$14.07

TETRAHYDROZOLN OPH SOL 0.05%

Facility

$28.14

Service Code	NDC 74300000803
Hospital Charge Code	60628082
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.22

TFCC FAST FIX KIT

Facility

$2,965.00

Hospital Charge Code	270675400
Hospital Revenue Code	272
Min. Negotiated Rate	$385.45
Max. Negotiated Rate	$1,482.50
Rate for Payer: Aetna Commercial	$889.50
Rate for Payer: Aetna Medicare Advantage	$889.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$756.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$756.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$756.08
Rate for Payer: Cigna Commercial	$1,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$385.45
Rate for Payer: Oxford Commercial	$1,482.50
Rate for Payer: Qualcare PPO/HMO/WC	$444.75
Rate for Payer: UnitedHealthcare Commercial	$1,482.50

TFCC FAST FIX KIT

Facility

$2,965.00

Hospital Charge Code	270675400
Hospital Revenue Code	272
Min. Negotiated Rate	$444.75
Max. Negotiated Rate	$444.75
Rate for Payer: Qualcare PPO/HMO/WC	$444.75

TFNA 10MM 130D 320MM LT

Facility

$11,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270694883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$3,585.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

TFNA 10MM 130D 320MM LT

Facility

$11,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270694883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

TFNA 10MM130DEGTI CANN440MM LT

Facility

$9,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270693114
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.00
Max. Negotiated Rate	$4,970.00
Rate for Payer: Aetna Commercial	$2,982.00
Rate for Payer: Aetna Medicare Advantage	$2,982.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,534.70
Rate for Payer: Cigna Commercial	$4,970.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,405.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.00

TFNA 10MM130DEGTI CANN440MM LT

Facility

$9,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270693114
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.00
Max. Negotiated Rate	$2,405.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,405.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.00

TFNA 11MM 130D TI 235MM RT

Facility

$22,045.00

Service Code	HCPCS C1776
Hospital Charge Code	270694976
Hospital Revenue Code	278
Min. Negotiated Rate	$3,306.75
Max. Negotiated Rate	$11,022.50
Rate for Payer: Aetna Commercial	$6,613.50
Rate for Payer: Aetna Medicare Advantage	$6,613.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,621.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,621.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,621.48
Rate for Payer: Cigna Commercial	$11,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75

TFNA 11MM 130D TI 235MM RT

Facility

$22,045.00

Service Code	HCPCS C1776
Hospital Charge Code	270694976
Hospital Revenue Code	278
Min. Negotiated Rate	$3,306.75
Max. Negotiated Rate	$5,334.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75

TFNA 380MM LT 10MM/130 DEG TI

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270679686
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.97
Max. Negotiated Rate	$2,336.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97

TFNA 380MM LT 10MM/130 DEG TI

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270679686
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.97
Max. Negotiated Rate	$4,826.57
Rate for Payer: Aetna Commercial	$2,895.95
Rate for Payer: Aetna Medicare Advantage	$2,895.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,461.55
Rate for Payer: Cigna Commercial	$4,826.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97

TFNA CANN 10MM/130/360

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270677487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.97
Max. Negotiated Rate	$2,336.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97

TFNA CANN 10MM/130/360

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270677487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.97
Max. Negotiated Rate	$4,826.57
Rate for Payer: Aetna Commercial	$2,895.95
Rate for Payer: Aetna Medicare Advantage	$2,895.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,461.55
Rate for Payer: Cigna Commercial	$4,826.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97

TFNA CANN 11MM 130D 235MM LT

Facility

$22,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270700152
Hospital Revenue Code	278
Min. Negotiated Rate	$3,306.75
Max. Negotiated Rate	$5,334.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75

Know your out-of-pocket cost for care.

All Charges