Heights University Hospital

All Charges

Charge

Type

Setting

Price

TOLBUTAMIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60628239
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TOLBUTAMIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60628239
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

TOLCAPONE 100 MG TAB

Facility

$20.85

Hospital Charge Code	60628768
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$6.25
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$10.43

TOLCAPONE 100 MG TAB

Facility

$20.85

Hospital Charge Code	60628768
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

TOLECTIN 600/600MG/TAB

Facility

$6.00

Hospital Charge Code	60634039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

TOLECTIN 600/600MG/TAB

Facility

$6.00

Hospital Charge Code	60634039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TOLECTIN DS/400MG/CAP

Facility

$3.00

Hospital Charge Code	60634402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TOLECTIN DS/400MG/CAP

Facility

$3.00

Hospital Charge Code	60634402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

TOLERANCE TEST #1

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

TOLERANCE TEST #1

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

TOLERANCE TEST #2

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

TOLERANCE TEST #2

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

TOLERANCE TEST #3

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419D
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

TOLERANCE TEST #3

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419D
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

TOLERANCE TEST #4

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419E
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

TOLERANCE TEST #4

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419E
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

TOLERANCE TEST #5

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419F
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

TOLERANCE TEST #5

Facility

$13.10

Service Code	HCPCS 82952
Hospital Charge Code	3001419F
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

TOLINASE/100MG/TAB

Facility

$3.00

Hospital Charge Code	60634234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

TOLINASE/100MG/TAB

Facility

$3.00

Hospital Charge Code	60634234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TOLINASE/250MG/TAB

Facility

$6.00

Hospital Charge Code	60634040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

TOLINASE/250MG/TAB

Facility

$6.00

Hospital Charge Code	60634040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TOLMETIN 200 MG TAB

Facility

$9.65

Hospital Charge Code	60627699
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

TOLMETIN 200 MG TAB

Facility

$9.65

Hospital Charge Code	60627699
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

TOLNAFTATE 1%/15GM

Facility

$6.00

Hospital Charge Code	60634041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges