Heights University Hospital

All Charges

Charge

Type

Setting

Price

THIORIDAZINE SSP 25MG/5ML

Facility

$1.95

Hospital Charge Code	60627822
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

THIORIDAZINE SSP 25MG/5ML

Facility

$1.95

Hospital Charge Code	60627822
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

THIOTEPA/15MG

Facility

$414.00

Hospital Charge Code	60634021
Hospital Revenue Code	636
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

THIOTEPA/15MG

Facility

$414.00

Hospital Charge Code	60634021
Hospital Revenue Code	636
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

THIOTEPA OPH DRP .5MG/ML

Facility

$256.65

Hospital Charge Code	6006084
Hospital Revenue Code	636
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$62.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.11
Rate for Payer: Qualcare PPO/HMO/WC	$38.50

THIOTEPA OPH DRP .5MG/ML

Facility

$256.65

Hospital Charge Code	6006084
Hospital Revenue Code	636
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$128.32
Rate for Payer: Aetna Commercial	$77.00
Rate for Payer: Aetna Medicare Advantage	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.45
Rate for Payer: Cigna Commercial	$128.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.11
Rate for Payer: Qualcare PPO/HMO/WC	$38.50

THIOTEPA VL 15MG

Facility

$585.60

Hospital Charge Code	6006795
Hospital Revenue Code	636
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$292.80
Rate for Payer: Aetna Commercial	$175.68
Rate for Payer: Aetna Medicare Advantage	$175.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.33
Rate for Payer: Cigna Commercial	$292.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.72
Rate for Payer: Qualcare PPO/HMO/WC	$87.84

THIOTEPA VL 15MG

Facility

$585.60

Hospital Charge Code	6006795
Hospital Revenue Code	636
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$141.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.72
Rate for Payer: Qualcare PPO/HMO/WC	$87.84

THIOTHIXENE 10 MG CAP

Facility

$34.24

Service Code	NDC 51079058920
Hospital Charge Code	6063943254
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

THIOTHIXENE 10 MG CAP

Facility

$5.65

Hospital Charge Code	60627828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

THIOTHIXENE 10 MG CAP

Facility

$5.65

Hospital Charge Code	60627828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

THIOTHIXENE 10 MG CAP

Facility

$34.24

Service Code	NDC 51079058920
Hospital Charge Code	6063943254
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$17.12
Rate for Payer: Aetna Commercial	$10.27
Rate for Payer: Aetna Medicare Advantage	$10.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.73
Rate for Payer: Cigna Commercial	$17.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.45
Rate for Payer: Oxford Commercial	$17.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$17.12

THIOTHIXENE 1 MG CAP

Facility

$4.00

Service Code	NDC 781222601
Hospital Charge Code	60627826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

THIOTHIXENE 1 MG CAP

Facility

$4.00

Service Code	NDC 781222601
Hospital Charge Code	60627826
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

THIOTHIXENE 2 MG CAP

Facility

$16.01

Service Code	NDC 51079058720
Hospital Charge Code	60627827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

THIOTHIXENE 2 MG CAP

Facility

$16.01

Service Code	NDC 51079058720
Hospital Charge Code	60627827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$8.01
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$8.01

THIOTHIXENE 5 MG CAP

Facility

$15.95

Service Code	NDC 378300501
Hospital Charge Code	6063943255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Qualcare PPO/HMO/WC	$2.39

THIOTHIXENE 5 MG CAP

Facility

$15.95

Service Code	NDC 378300501
Hospital Charge Code	6063943255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$7.97
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: Aetna Medicare Advantage	$4.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.07
Rate for Payer: Cigna Commercial	$7.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$7.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.39
Rate for Payer: UnitedHealthcare Commercial	$7.97

THIOTHIXENE 5 MG/ML ORAL CONC.

Facility

$326.45

Hospital Charge Code	60627829
Hospital Revenue Code	250
Min. Negotiated Rate	$42.44
Max. Negotiated Rate	$163.22
Rate for Payer: Aetna Commercial	$97.94
Rate for Payer: Aetna Medicare Advantage	$97.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.24
Rate for Payer: Cigna Commercial	$163.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.44
Rate for Payer: Oxford Commercial	$163.22
Rate for Payer: Qualcare PPO/HMO/WC	$48.97
Rate for Payer: UnitedHealthcare Commercial	$163.22

THIOTHIXENE 5 MG/ML ORAL CONC.

Facility

$326.45

Hospital Charge Code	60627829
Hospital Revenue Code	250
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.97

THIOTHIXENE CAP 10MG

Facility

$5.80

Hospital Charge Code	60627825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

THIOTHIXENE CAP 10MG

Facility

$5.80

Hospital Charge Code	60627825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

THIOTHIXENE INJ 5MG/ML 2ML

Facility

$37.00

Service Code	HCPCS J2330
Hospital Charge Code	6006092
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

THIOTHIXENE INJ 5MG/ML 2ML

Facility

$37.00

Service Code	HCPCS J2330
Hospital Charge Code	6006092
Hospital Revenue Code	250
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.81
Rate for Payer: Oxford Commercial	$18.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$18.50

THIOTHIXENE (NAVANE)

Facility

$324.00

Service Code	HCPCS 82542
Hospital Charge Code	38473123
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

Know your out-of-pocket cost for care.

All Charges