Heights University Hospital

All Charges

Charge

Type

Setting

Price

THIAMINE 100 MG TAB

Facility

$4.00

Service Code	NDC 10135013210
Hospital Charge Code	60628487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

THIAMINE 100 MG TAB

Facility

$4.00

Service Code	NDC 10135013210
Hospital Charge Code	60628487
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

THIAMINE/100MG/TAB

Facility

$1.00

Hospital Charge Code	60634017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

THIAMINE/100MG/TAB

Facility

$1.00

Hospital Charge Code	60634017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

THIAMINE 50 MG TAB UD

Facility

$4.00

Service Code	NDC 10135013101
Hospital Charge Code	60628488
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

THIAMINE 50 MG TAB UD

Facility

$4.00

Service Code	NDC 10135013101
Hospital Charge Code	60628488
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

THIMOLOL OPH .25% 5ML

Facility

$19.85

Hospital Charge Code	6006134
Hospital Revenue Code	251
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

THIMOLOL OPH .25% 5ML

Facility

$19.85

Hospital Charge Code	6006134
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

THIN LONG BLADE 8MM

Facility

$1,062.00

Hospital Charge Code	270685392
Hospital Revenue Code	272
Min. Negotiated Rate	$138.06
Max. Negotiated Rate	$531.00
Rate for Payer: Aetna Commercial	$318.60
Rate for Payer: Aetna Medicare Advantage	$318.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.81
Rate for Payer: Cigna Commercial	$531.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.06
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.30
Rate for Payer: UnitedHealthcare Commercial	$531.00

THIN LONG BLADE 8MM

Facility

$1,062.00

Hospital Charge Code	270685392
Hospital Revenue Code	272
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Qualcare PPO/HMO/WC	$159.30

THINPREP -TIS

Facility

$176.15

Service Code	HCPCS 88175
Hospital Charge Code	39900313
Hospital Revenue Code	311
Min. Negotiated Rate	$26.42
Max. Negotiated Rate	$26.42
Rate for Payer: Qualcare PPO/HMO/WC	$26.42

THINPREP -TIS

Facility

$176.15

Service Code	HCPCS 88175
Hospital Charge Code	39900313
Hospital Revenue Code	311
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.42
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

THIOCYANATE (SERUM)

Facility

$205.65

Service Code	HCPCS 84430
Hospital Charge Code	3009099
Hospital Revenue Code	301
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

THIOCYANATE (SERUM)

Facility

$205.65

Service Code	HCPCS 84430
Hospital Charge Code	3009099
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.68
Rate for Payer: Aetna Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.61
Rate for Payer: Cigna Commercial	$11.63
Rate for Payer: Cigna Medicare Advantage	$5.82
Rate for Payer: Clover Medicare Advantage	$11.05
Rate for Payer: EmblemHealth Commercial	$34.89
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.33
Rate for Payer: Wellcare Medicare Advantage	$11.63

THIOCYANATE, SERUM

Facility

$259.00

Service Code	HCPCS 84430
Hospital Charge Code	38472034
Hospital Revenue Code	301
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

THIOCYANATE, SERUM

Facility

$259.00

Service Code	HCPCS 84430
Hospital Charge Code	38472034
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.68
Rate for Payer: Aetna Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.61
Rate for Payer: Cigna Commercial	$11.63
Rate for Payer: Cigna Medicare Advantage	$5.82
Rate for Payer: Clover Medicare Advantage	$11.05
Rate for Payer: EmblemHealth Commercial	$34.89
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.33
Rate for Payer: Wellcare Medicare Advantage	$11.63

THIOCYANATE,URINE

Facility

$259.00

Service Code	HCPCS 84430
Hospital Charge Code	38472633
Hospital Revenue Code	301
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

THIOCYANATE,URINE

Facility

$259.00

Service Code	HCPCS 84430
Hospital Charge Code	38472633
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.68
Rate for Payer: Aetna Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.61
Rate for Payer: Cigna Commercial	$11.63
Rate for Payer: Cigna Medicare Advantage	$5.82
Rate for Payer: Clover Medicare Advantage	$11.05
Rate for Payer: EmblemHealth Commercial	$34.89
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.33
Rate for Payer: Wellcare Medicare Advantage	$11.63

THIOGUANINE/40MG/TAB

Facility

$13.00

Hospital Charge Code	60634019
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

THIOGUANINE/40MG/TAB

Facility

$13.00

Hospital Charge Code	60634019
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

THIOPENTAL 400 MG INJ

Facility

$119.25

Hospital Charge Code	60627674
Hospital Revenue Code	250
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

THIOPENTAL 400 MG INJ

Facility

$119.25

Hospital Charge Code	60627674
Hospital Revenue Code	250
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$59.62
Rate for Payer: Aetna Commercial	$35.77
Rate for Payer: Aetna Medicare Advantage	$35.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.41
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$59.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$59.62

THIOPENTAL 500 MG REC

Facility

$13.20

Hospital Charge Code	60629879
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

THIOPENTAL 500 MG REC

Facility

$13.20

Hospital Charge Code	60629879
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.72
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$6.60

THIOPENTAL SOD INJ 25MG/ML 20M

Facility

$74.90

Hospital Charge Code	6005318
Hospital Revenue Code	250
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$22.47
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.74
Rate for Payer: Oxford Commercial	$37.45
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$37.45

Know your out-of-pocket cost for care.

All Charges