Heights University Hospital

All Charges

Charge

Type

Setting

Price

TOPIRAMATE (TOPAMAX) 50MG TAB

Facility

$29.61

Service Code	NDC 68462015360
Hospital Charge Code	60630145
Hospital Revenue Code	250
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$4.44
Rate for Payer: Qualcare PPO/HMO/WC	$4.44

TOPOTECAN HCL INJ 4MG

Facility

$2,073.00

Hospital Charge Code	6017024
Hospital Revenue Code	636
Min. Negotiated Rate	$310.95
Max. Negotiated Rate	$1,036.50
Rate for Payer: Aetna Commercial	$621.90
Rate for Payer: Aetna Medicare Advantage	$621.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.62
Rate for Payer: Cigna Commercial	$1,036.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.67
Rate for Payer: Qualcare PPO/HMO/WC	$310.95

TOPOTECAN HCL INJ 4MG

Facility

$2,073.00

Hospital Charge Code	6017024
Hospital Revenue Code	636
Min. Negotiated Rate	$310.95
Max. Negotiated Rate	$501.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.67
Rate for Payer: Qualcare PPO/HMO/WC	$310.95

TOPROL-XL 100MG TAB

Facility

$7.00

Hospital Charge Code	60635167
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

TOPROL-XL 100MG TAB

Facility

$7.00

Hospital Charge Code	60635167
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TOPROL XL 200MG

Facility

$16.88

Service Code	NDC 70347020002
Hospital Charge Code	60635251
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$5.06
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.44

TOPROL XL 200MG

Facility

$16.88

Service Code	NDC 70347020002
Hospital Charge Code	60635251
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

TOPROL XL 25MG

Facility

$2.00

Hospital Charge Code	60635397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TOPROL XL 25MG

Facility

$2.00

Hospital Charge Code	60635397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

TOP SCRUB 2PKT, MISTY ENCORE

Facility

$20.80

Hospital Charge Code	270658924
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.12

TOP SCRUB 2PKT, MISTY ENCORE

Facility

$20.80

Hospital Charge Code	270658924
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Aetna Medicare Advantage	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.30
Rate for Payer: Cigna Commercial	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.12
Rate for Payer: UnitedHealthcare Commercial	$10.40

TORADOL/10MG/U/D

Facility

$15.21

Service Code	NDC 378113401
Hospital Charge Code	60634935
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$7.61
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.88
Rate for Payer: Cigna Commercial	$7.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.98
Rate for Payer: Oxford Commercial	$7.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.28
Rate for Payer: UnitedHealthcare Commercial	$7.61

TORADOL/10MG/U/D

Facility

$15.21

Service Code	NDC 378113401
Hospital Charge Code	60634935
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.28

TORADOL INJ

Facility

$4.00

Hospital Charge Code	60634806
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TORADOL INJ

Facility

$4.00

Hospital Charge Code	60634806
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TORADOL INJ/30MG

Facility

$42.00

Hospital Charge Code	60634819
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$10.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

TORADOL INJ/30MG

Facility

$42.00

Hospital Charge Code	60634819
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

TORADOL/INJ/30MG

Facility

$48.00

Hospital Charge Code	60634739
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TORADOL/INJ/30MG

Facility

$48.00

Hospital Charge Code	60634739
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TORADOL INJ/60MG

Facility

$42.00

Hospital Charge Code	60634820
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

TORADOL INJ/60MG

Facility

$42.00

Hospital Charge Code	60634820
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$10.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

TORADOL/INJ/60MG

Facility

$48.00

Hospital Charge Code	60634740
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TORADOL/INJ/60MG

Facility

$48.00

Hospital Charge Code	60634740
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TORADOL TABS/10MG

Facility

$6.00

Hospital Charge Code	60634741
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

TORADOL TABS/10MG

Facility

$6.00

Hospital Charge Code	60634741
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