Heights University Hospital

All Charges

Charge

Type

Setting

Price

TICK IDENTIFICATION

Facility

$29.35

Service Code	HCPCS 87168
Hospital Charge Code	39900274
Hospital Revenue Code	309
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.40

TICLOPIDINE 250 MG TAB

Facility

$13.33

Service Code	NDC 57664032786
Hospital Charge Code	60628554
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.73
Rate for Payer: Oxford Commercial	$6.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$6.67

TICLOPIDINE 250 MG TAB

Facility

$13.33

Service Code	NDC 57664032786
Hospital Charge Code	60628554
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

TICLOPIDINE HCL/250MG/UD

Facility

$5.00

Hospital Charge Code	60634666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

TICLOPIDINE HCL/250MG/UD

Facility

$5.00

Hospital Charge Code	60634666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TICLOPIDINE HCL TAB 250MG

Facility

$13.45

Hospital Charge Code	6027072
Hospital Revenue Code	252
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$6.72
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$6.72

TICLOPIDINE HCL TAB 250MG

Facility

$13.45

Hospital Charge Code	6027072
Hospital Revenue Code	252
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

TICLOPIDINE TAB 250MG

Facility

$10.25

Hospital Charge Code	60628721
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

TICLOPIDINE TAB 250MG

Facility

$10.25

Hospital Charge Code	60628721
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.61
Rate for Payer: Cigna Commercial	$5.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.12

TICLOPIDINE TAB 250MG

Facility

$10.90

Hospital Charge Code	6017776
Hospital Revenue Code	252
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

TICLOPIDINE TAB 250MG

Facility

$10.90

Hospital Charge Code	6017776
Hospital Revenue Code	252
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

TIE JUGGERKNOT 1.0 2-0

Facility

$1,890.00

Hospital Charge Code	270661836
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: Aetna Medicare Advantage	$567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.95
Rate for Payer: Cigna Commercial	$945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.38
Rate for Payer: Qualcare PPO/HMO/WC	$283.50

TIE JUGGERKNOT 1.0 2-0

Facility

$1,890.00

Hospital Charge Code	270661836
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$457.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.38
Rate for Payer: Qualcare PPO/HMO/WC	$283.50

TIE JUGGERKNOT 1.0 3-0

Facility

$1,890.00

Hospital Charge Code	270661848
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$457.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.38
Rate for Payer: Qualcare PPO/HMO/WC	$283.50

TIE JUGGERKNOT 1.0 3-0

Facility

$1,890.00

Hospital Charge Code	270661848
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna Commercial	$567.00
Rate for Payer: Aetna Medicare Advantage	$567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.95
Rate for Payer: Cigna Commercial	$945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.38
Rate for Payer: Qualcare PPO/HMO/WC	$283.50

TI END CAP TIBIAL NAIL STRDRV

Facility

$1,103.15

Service Code	HCPCS C1713
Hospital Charge Code	270678634
Hospital Revenue Code	278
Min. Negotiated Rate	$165.47
Max. Negotiated Rate	$551.58
Rate for Payer: Aetna Commercial	$330.94
Rate for Payer: Aetna Medicare Advantage	$330.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.30
Rate for Payer: Cigna Commercial	$551.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.96
Rate for Payer: Qualcare PPO/HMO/WC	$165.47

TI END CAP TIBIAL NAIL STRDRV

Facility

$1,103.15

Service Code	HCPCS C1713
Hospital Charge Code	270678634
Hospital Revenue Code	278
Min. Negotiated Rate	$165.47
Max. Negotiated Rate	$266.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.96
Rate for Payer: Qualcare PPO/HMO/WC	$165.47

TIGAN/100MG/1ML

Facility

$18.00

Hospital Charge Code	60634027
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

TIGAN/100MG/1ML

Facility

$18.00

Hospital Charge Code	60634027
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TIGAN/100MG/CAP

Facility

$4.00

Hospital Charge Code	60634810
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

TIGAN/100MG/CAP

Facility

$4.00

Hospital Charge Code	60634810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TIGAN/100MG/EACH

Facility

$4.00

Hospital Charge Code	60634028
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

TIGAN/100MG/EACH

Facility

$4.00

Hospital Charge Code	60634028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TIGAN/200MG/EACH

Facility

$4.00

Hospital Charge Code	60634029
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

TIGAN/200MG/EACH

Facility

$4.00

Hospital Charge Code	60634029
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges