Heights University Hospital

All Charges

Charge

Type

Setting

Price

TOPICAL COMPOUND

Facility

$215.05

Hospital Charge Code	6010326
Hospital Revenue Code	251
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$107.53
Rate for Payer: Aetna Commercial	$64.52
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.96
Rate for Payer: Oxford Commercial	$107.53
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$107.53

TOPICAL COMPOUND

Facility

$215.05

Hospital Charge Code	6010326
Hospital Revenue Code	251
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

TOPICAL FIBRINOLYSIN OINT

Facility

$383.25

Hospital Charge Code	60628459
Hospital Revenue Code	250
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

TOPICAL FIBRINOLYSIN OINT

Facility

$383.25

Hospital Charge Code	60628459
Hospital Revenue Code	250
Min. Negotiated Rate	$49.82
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$114.97
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.82
Rate for Payer: Oxford Commercial	$191.62
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$191.62

TOPICAL SKIN ADHESIVE 35ML

Facility

$798.60

Hospital Charge Code	270663132
Hospital Revenue Code	270
Min. Negotiated Rate	$103.82
Max. Negotiated Rate	$399.30
Rate for Payer: Aetna Commercial	$239.58
Rate for Payer: Aetna Medicare Advantage	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.64
Rate for Payer: Cigna Commercial	$399.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.82
Rate for Payer: Oxford Commercial	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$119.79
Rate for Payer: UnitedHealthcare Commercial	$399.30

TOPICAL SKIN ADHESIVE 35ML

Facility

$798.60

Hospital Charge Code	270663132
Hospital Revenue Code	270
Min. Negotiated Rate	$119.79
Max. Negotiated Rate	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$119.79

TOPICAL SOL *******

Facility

$38.00

Hospital Charge Code	8001778
Hospital Revenue Code	279
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

TOPICAL SOL *******

Facility

$38.00

Hospital Charge Code	8001778
Hospital Revenue Code	279
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

TOPICAL THROMBIN VL 10,000U

Facility

$515.20

Hospital Charge Code	6006803
Hospital Revenue Code	250
Min. Negotiated Rate	$66.98
Max. Negotiated Rate	$257.60
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna Medicare Advantage	$154.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.38
Rate for Payer: Cigna Commercial	$257.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.98
Rate for Payer: Oxford Commercial	$257.60
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Commercial	$257.60

TOPICAL THROMBIN VL 10,000U

Facility

$515.20

Hospital Charge Code	6006803
Hospital Revenue Code	250
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

TOPICORT 0.25%/15GM

Facility

$8.00

Hospital Charge Code	60634044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

TOPICORT 0.25%/15GM

Facility

$8.00

Hospital Charge Code	60634044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

TOPICORT 0.25%/60GM

Facility

$158.00

Hospital Charge Code	60634045
Hospital Revenue Code	250
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$47.40
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$79.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$79.00

TOPICORT 0.25%/60GM

Facility

$158.00

Hospital Charge Code	60634045
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

TOPIRAMATE

Facility

$390.00

Service Code	HCPCS 80201
Hospital Charge Code	39900012
Hospital Revenue Code	301
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.62
Rate for Payer: Aetna Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.67
Rate for Payer: Cigna Commercial	$11.92
Rate for Payer: Cigna Medicare Advantage	$5.96
Rate for Payer: Clover Medicare Advantage	$11.32
Rate for Payer: EmblemHealth Commercial	$35.76
Rate for Payer: Humana Medicare Advantage	$12.28
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	$11.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.64
Rate for Payer: Wellcare Medicare Advantage	$11.92

TOPIRAMATE

Facility

$390.00

Service Code	HCPCS 80201
Hospital Charge Code	39900012
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TOPIRAMATE 200 MG TAB

Facility

$112.02

Service Code	NDC 50458064265
Hospital Charge Code	60629916
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

TOPIRAMATE 200 MG TAB

Facility

$112.02

Service Code	NDC 50458064265
Hospital Charge Code	60629916
Hospital Revenue Code	250
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$56.01
Rate for Payer: Aetna Commercial	$33.61
Rate for Payer: Aetna Medicare Advantage	$33.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.57
Rate for Payer: Cigna Commercial	$56.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.56
Rate for Payer: Oxford Commercial	$56.01
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$56.01

TOPIRAMATE 25 MG TAB

Facility

$35.11

Service Code	NDC 50458063965
Hospital Charge Code	60628972
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Oxford Commercial	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$17.55

TOPIRAMATE 25 MG TAB

Facility

$35.11

Service Code	NDC 50458063965
Hospital Charge Code	60628972
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

TOPIRAMATE SERUM (TOPAMAX)

Facility

$128.00

Service Code	HCPCS 80201
Hospital Charge Code	3002583
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TOPIRAMATE SERUM (TOPAMAX)

Facility

$128.00

Service Code	HCPCS 80201
Hospital Charge Code	3002583
Hospital Revenue Code	301
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.62
Rate for Payer: Aetna Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.67
Rate for Payer: Cigna Commercial	$11.92
Rate for Payer: Cigna Medicare Advantage	$5.96
Rate for Payer: Clover Medicare Advantage	$11.32
Rate for Payer: EmblemHealth Commercial	$35.76
Rate for Payer: Humana Medicare Advantage	$12.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.64
Rate for Payer: Wellcare Medicare Advantage	$11.92

TOPIRAMATE (TOPAMAX) 100MF TAB

Facility

$40.47

Service Code	NDC 68462010960
Hospital Charge Code	60630146
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

TOPIRAMATE (TOPAMAX) 100MF TAB

Facility

$40.47

Service Code	NDC 68462010960
Hospital Charge Code	60630146
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.07

TOPIRAMATE (TOPAMAX) 50MG TAB

Facility

$29.61

Service Code	NDC 68462015360
Hospital Charge Code	60630145
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.80
Rate for Payer: Aetna Commercial	$8.88
Rate for Payer: Aetna Medicare Advantage	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.55
Rate for Payer: Cigna Commercial	$14.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.44
Rate for Payer: UnitedHealthcare Commercial	$14.80

Know your out-of-pocket cost for care.

All Charges