Heights University Hospital

All Charges

Charge

Type

Setting

Price

TOLNAFTATE 1%/15GM

Facility

$6.00

Hospital Charge Code	60634041
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

TOLNAFTATE 1%/15ML

Facility

$6.00

Hospital Charge Code	60634042
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TOLNAFTATE 1%/15ML

Facility

$6.00

Hospital Charge Code	60634042
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

TOLNAFTATE 1 % CRE

Facility

$2.45

Hospital Charge Code	6010078
Hospital Revenue Code	251
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

TOLNAFTATE 1 % CRE

Facility

$2.45

Hospital Charge Code	6010078
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TOLNAFTATE TOPICAL 1% SOLN

Facility

$23.00

Hospital Charge Code	60628347
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

TOLNAFTATE TOPICAL 1% SOLN

Facility

$23.00

Hospital Charge Code	60628347
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

TOLTERODINE 1 MG TAB

Facility

$41.81

Service Code	NDC 58151009891
Hospital Charge Code	60629012
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$20.91
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.66
Rate for Payer: Cigna Commercial	$20.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.44
Rate for Payer: Oxford Commercial	$20.91
Rate for Payer: Qualcare PPO/HMO/WC	$6.27
Rate for Payer: UnitedHealthcare Commercial	$20.91

TOLTERODINE 1 MG TAB

Facility

$41.81

Service Code	NDC 58151009891
Hospital Charge Code	60629012
Hospital Revenue Code	250
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$6.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.27

TOLTERODINE 2 MG TAB

Facility

$43.35

Service Code	NDC 9454401
Hospital Charge Code	60628907
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.50

TOLTERODINE 2 MG TAB

Facility

$43.35

Service Code	NDC 9454401
Hospital Charge Code	60628907
Hospital Revenue Code	250
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$21.68
Rate for Payer: Aetna Commercial	$13.01
Rate for Payer: Aetna Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.05
Rate for Payer: Cigna Commercial	$21.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.64
Rate for Payer: Oxford Commercial	$21.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.50
Rate for Payer: UnitedHealthcare Commercial	$21.68

TOLTERODINE 4 MG ER UD

Facility

$71.82

Service Code	NDC 9519004
Hospital Charge Code	60628968
Hospital Revenue Code	250
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$35.91
Rate for Payer: Aetna Commercial	$21.55
Rate for Payer: Aetna Medicare Advantage	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.31
Rate for Payer: Cigna Commercial	$35.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.34
Rate for Payer: Oxford Commercial	$35.91
Rate for Payer: Qualcare PPO/HMO/WC	$10.77
Rate for Payer: UnitedHealthcare Commercial	$35.91

TOLTERODINE 4 MG ER UD

Facility

$71.82

Service Code	NDC 9519004
Hospital Charge Code	60628968
Hospital Revenue Code	250
Min. Negotiated Rate	$10.77
Max. Negotiated Rate	$10.77
Rate for Payer: Qualcare PPO/HMO/WC	$10.77

TOLTERODINE LA (DETROL LA) 2MG

Facility

$40.47

Service Code	NDC 58151010393
Hospital Charge Code	60630144
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.07

TOLTERODINE LA (DETROL LA) 2MG

Facility

$40.47

Service Code	NDC 58151010393
Hospital Charge Code	60630144
Hospital Revenue Code	250
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$20.23
Rate for Payer: Aetna Commercial	$12.14
Rate for Payer: Aetna Medicare Advantage	$12.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.32
Rate for Payer: Cigna Commercial	$20.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.26
Rate for Payer: Oxford Commercial	$20.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.07
Rate for Payer: UnitedHealthcare Commercial	$20.23

TOLVAPTAN 15 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002050
Hospital Charge Code	60630114
Hospital Revenue Code	250
Min. Negotiated Rate	$345.76
Max. Negotiated Rate	$345.76
Rate for Payer: Qualcare PPO/HMO/WC	$345.76

TOLVAPTAN 15 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002050
Hospital Charge Code	60630114
Hospital Revenue Code	250
Min. Negotiated Rate	$299.66
Max. Negotiated Rate	$1,152.54
Rate for Payer: Aetna Commercial	$691.52
Rate for Payer: Aetna Medicare Advantage	$691.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.79
Rate for Payer: Cigna Commercial	$1,152.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.66
Rate for Payer: Oxford Commercial	$1,152.54
Rate for Payer: Qualcare PPO/HMO/WC	$345.76
Rate for Payer: UnitedHealthcare Commercial	$1,152.54

TOLVAPTAN 30 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002150
Hospital Charge Code	60630115
Hospital Revenue Code	250
Min. Negotiated Rate	$345.76
Max. Negotiated Rate	$345.76
Rate for Payer: Qualcare PPO/HMO/WC	$345.76

TOLVAPTAN 30 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002150
Hospital Charge Code	60630115
Hospital Revenue Code	250
Min. Negotiated Rate	$299.66
Max. Negotiated Rate	$1,152.54
Rate for Payer: Aetna Commercial	$691.52
Rate for Payer: Aetna Medicare Advantage	$691.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.79
Rate for Payer: Cigna Commercial	$1,152.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.66
Rate for Payer: Oxford Commercial	$1,152.54
Rate for Payer: Qualcare PPO/HMO/WC	$345.76
Rate for Payer: UnitedHealthcare Commercial	$1,152.54

TOMO DIAG BREAST BIL

Facility

$4,500.00

Service Code	HCPCS 77062
Hospital Charge Code	94061474
Hospital Revenue Code	401
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

TOMO DIAG BREAST BIL

Facility

$4,500.00

Service Code	HCPCS 77062
Hospital Charge Code	94061474
Hospital Revenue Code	401
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

TOMO DIAG BREAST UNI

Facility

$4,500.00

Service Code	HCPCS 77061
Hospital Charge Code	94061471
Hospital Revenue Code	401
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

TOMO DIAG BREAST UNI

Facility

$4,500.00

Service Code	HCPCS 77061
Hospital Charge Code	94061471
Hospital Revenue Code	401
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

TOMOSYNTHESIS SCREEN BREAST BI

Facility

$260.20

Service Code	HCPCS 77063
Hospital Charge Code	94061470
Hospital Revenue Code	403
Min. Negotiated Rate	$39.03
Max. Negotiated Rate	$39.03
Rate for Payer: Qualcare PPO/HMO/WC	$39.03

TOMOSYNTHESIS SCREEN BREAST BI

Facility

$260.20

Service Code	HCPCS 77063
Hospital Charge Code	94061470
Hospital Revenue Code	403
Min. Negotiated Rate	$33.83
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$78.06
Rate for Payer: Aetna Medicare Advantage	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.35
Rate for Payer: Cigna Commercial	$57.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.83
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.03
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

Know your out-of-pocket cost for care.

All Charges