Heights University Hospital

All Charges

Charge

Type

Setting

Price

TOBRAMYCIN DEXTHSN OPH OINT

Facility

$1,499.46

Service Code	NDC 78087601
Hospital Charge Code	60628024
Hospital Revenue Code	250
Min. Negotiated Rate	$224.92
Max. Negotiated Rate	$224.92
Rate for Payer: Qualcare PPO/HMO/WC	$224.92

TOBRAMYCIN DEXTHSN OPH SSP

Facility

$566.42

Service Code	NDC 78095340
Hospital Charge Code	60628025
Hospital Revenue Code	250
Min. Negotiated Rate	$73.63
Max. Negotiated Rate	$283.21
Rate for Payer: Aetna Commercial	$169.93
Rate for Payer: Aetna Medicare Advantage	$169.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.44
Rate for Payer: Cigna Commercial	$283.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.63
Rate for Payer: Oxford Commercial	$283.21
Rate for Payer: Qualcare PPO/HMO/WC	$84.96
Rate for Payer: UnitedHealthcare Commercial	$283.21

TOBRAMYCIN DEXTHSN OPH SSP

Facility

$566.42

Service Code	NDC 78095340
Hospital Charge Code	60628025
Hospital Revenue Code	250
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$84.96
Rate for Payer: Qualcare PPO/HMO/WC	$84.96

TOBRAMYCIN DEXTHSN OPT SOL 5ML

Facility

$174.75

Hospital Charge Code	6007421
Hospital Revenue Code	251
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$52.42
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.72
Rate for Payer: Oxford Commercial	$87.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$87.38

TOBRAMYCIN DEXTHSN OPT SOL 5ML

Facility

$174.75

Hospital Charge Code	6007421
Hospital Revenue Code	251
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

TOBRAMYCIN OPH DROPS

Facility

$174.75

Hospital Charge Code	6005367
Hospital Revenue Code	251
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$52.42
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.72
Rate for Payer: Oxford Commercial	$87.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$87.38

TOBRAMYCIN OPH DROPS

Facility

$174.75

Hospital Charge Code	6005367
Hospital Revenue Code	251
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

TOBRAMYCIN OPH ITV 2MG/ML

Facility

$61.45

Hospital Charge Code	6005359
Hospital Revenue Code	251
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

TOBRAMYCIN OPH ITV 2MG/ML

Facility

$61.45

Hospital Charge Code	6005359
Hospital Revenue Code	251
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

TOBRAMYCIN OPH OINT 0.3% 3.5GM

Facility

$41.60

Hospital Charge Code	6005334
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

TOBRAMYCIN OPH OINT 0.3% 3.5GM

Facility

$41.60

Hospital Charge Code	6005334
Hospital Revenue Code	251
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

TOBRAMYCIN OPH SOL .3% 5ML

Facility

$53.80

Hospital Charge Code	6005342
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

TOBRAMYCIN OPH SOL .3% 5ML

Facility

$53.80

Hospital Charge Code	6005342
Hospital Revenue Code	251
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

TOBRAMYCIN OPTH OINT

Facility

$604.61

Service Code	NDC 65064435
Hospital Charge Code	60628022
Hospital Revenue Code	250
Min. Negotiated Rate	$78.60
Max. Negotiated Rate	$302.31
Rate for Payer: Aetna Commercial	$181.38
Rate for Payer: Aetna Medicare Advantage	$181.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.18
Rate for Payer: Cigna Commercial	$302.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.60
Rate for Payer: Oxford Commercial	$302.31
Rate for Payer: Qualcare PPO/HMO/WC	$90.69
Rate for Payer: UnitedHealthcare Commercial	$302.31

TOBRAMYCIN OPTH OINT

Facility

$604.61

Service Code	NDC 65064435
Hospital Charge Code	60628022
Hospital Revenue Code	250
Min. Negotiated Rate	$90.69
Max. Negotiated Rate	$90.69
Rate for Payer: Qualcare PPO/HMO/WC	$90.69

TOBRAMYCIN OPTH SOL 0.3% 5ML

Facility

$98.42

Service Code	NDC 24208029005
Hospital Charge Code	60628023
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.76

TOBRAMYCIN OPTH SOL 0.3% 5ML

Facility

$98.42

Service Code	NDC 24208029005
Hospital Charge Code	60628023
Hospital Revenue Code	250
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$49.21
Rate for Payer: Aetna Commercial	$29.53
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.10
Rate for Payer: Cigna Commercial	$49.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.79
Rate for Payer: Oxford Commercial	$49.21
Rate for Payer: Qualcare PPO/HMO/WC	$14.76
Rate for Payer: UnitedHealthcare Commercial	$49.21

TOBRAMYCIN VL 1.2GM

Facility

$489.60

Hospital Charge Code	6010540
Hospital Revenue Code	250
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$73.44
Rate for Payer: Qualcare PPO/HMO/WC	$73.44

TOBRAMYCIN VL 1.2GM

Facility

$489.60

Hospital Charge Code	6010540
Hospital Revenue Code	250
Min. Negotiated Rate	$63.65
Max. Negotiated Rate	$244.80
Rate for Payer: Aetna Commercial	$146.88
Rate for Payer: Aetna Medicare Advantage	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.85
Rate for Payer: Cigna Commercial	$244.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.65
Rate for Payer: Oxford Commercial	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.44
Rate for Payer: UnitedHealthcare Commercial	$244.80

TOBREX 0.3% OPHTH/5ML

Facility

$97.00

Hospital Charge Code	60634035
Hospital Revenue Code	250
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

TOBREX 0.3% OPHTH/5ML

Facility

$97.00

Hospital Charge Code	60634035
Hospital Revenue Code	250
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$29.10
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.61
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$48.50

TOCAINIDE TAB 400MG

Facility

$10.45

Hospital Charge Code	60627612
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

TOCAINIDE TAB 400MG

Facility

$10.45

Hospital Charge Code	60627612
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

TOCAINIDE (TONOCARD)

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38473122
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

TOCAINIDE (TONOCARD)

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38473122
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

Know your out-of-pocket cost for care.

All Charges