Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIB&SCRW AUG BLK11MM LLAT/RMED

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270680668
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

TIB&SCRW AUG BLK11MM LLAT/RMED

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270680668
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,158.00
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

TIB&SCRW AUG BLK11MM RLAT/LMED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680669
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TIB&SCRW AUG BLK11MM RLAT/LMED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680669
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,158.30
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TI CAGE 9MM MEDIUM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TI CAGE 9MM MEDIUM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TICAGRELOR 90MG TAB

Facility

$36.45

Service Code	NDC 186077739
Hospital Charge Code	60630216
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

TICAGRELOR 90MG TAB

Facility

$36.45

Service Code	NDC 186077739
Hospital Charge Code	60630216
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

TI CANN FRN 10MM GT400MM

Facility

$8,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270688033
Hospital Revenue Code	278
Min. Negotiated Rate	$1,318.20
Max. Negotiated Rate	$2,126.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,757.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,126.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,318.20

TI CANN FRN 10MM GT400MM

Facility

$8,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270688033
Hospital Revenue Code	278
Min. Negotiated Rate	$1,318.20
Max. Negotiated Rate	$4,394.00
Rate for Payer: Aetna Commercial	$2,636.40
Rate for Payer: Aetna Medicare Advantage	$2,636.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,757.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,240.94
Rate for Payer: Cigna Commercial	$4,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,126.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,318.20

TICARCIL CLAV IVPB 3.1G/100ML

Facility

$105.00

Hospital Charge Code	60628878
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$52.50

TICARCIL CLAV IVPB 3.1G/100ML

Facility

$105.00

Hospital Charge Code	60628878
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

TICARCIL CLAV IVPB3.1G/NS 50ML

Facility

$86.40

Hospital Charge Code	60627315
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

TICARCIL CLAV IVPB3.1G/NS 50ML

Facility

$86.40

Hospital Charge Code	60627315
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$43.20

TICARCILLIN-CLAVULANATE3.1GINJ

Facility

$80.00

Hospital Charge Code	60629128
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

TICARCILLIN-CLAVULANATE3.1GINJ

Facility

$80.00

Hospital Charge Code	60629128
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

TICARCILLIN INJ 3GM

Facility

$109.45

Hospital Charge Code	6007108
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

TICARCILLIN INJ 3GM

Facility

$109.45

Hospital Charge Code	6007108
Hospital Revenue Code	250
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$54.73

TICK ID

Facility

$59.00

Service Code	HCPCS 87208
Hospital Charge Code	3006848
Hospital Revenue Code	306
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

TICK ID

Facility

$59.00

Service Code	HCPCS 87208
Hospital Charge Code	3006848
Hospital Revenue Code	306
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

TICK IDENTIFICATION

Facility

$390.00

Service Code	HCPCS 87172
Hospital Charge Code	3006833
Hospital Revenue Code	309
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.65
Rate for Payer: Cigna Commercial	$4.27
Rate for Payer: Cigna Medicare Advantage	$2.13
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
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	$4.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.53
Rate for Payer: Wellcare Medicare Advantage	$4.27

TICK IDENTIFICATION

Facility

$106.00

Service Code	HCPCS 87168
Hospital Charge Code	38475095
Hospital Revenue Code	309
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TICK IDENTIFICATION

Facility

$390.00

Service Code	HCPCS 87172
Hospital Charge Code	3006833
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TICK IDENTIFICATION

Facility

$106.00

Service Code	HCPCS 87168
Hospital Charge Code	38475095
Hospital Revenue Code	309
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.65
Rate for Payer: Cigna Commercial	$4.27
Rate for Payer: Cigna Medicare Advantage	$2.13
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.53
Rate for Payer: Wellcare Medicare Advantage	$4.27

TICK IDENTIFICATION

Facility

$29.35

Service Code	HCPCS 87168
Hospital Charge Code	39900274
Hospital Revenue Code	309
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.65
Rate for Payer: Cigna Commercial	$4.27
Rate for Payer: Cigna Medicare Advantage	$2.13
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.53
Rate for Payer: Wellcare Medicare Advantage	$4.27

Know your out-of-pocket cost for care.

All Charges