Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRAY TSR SHOULDER REV 0MM OFFS

Facility

$17,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270697092
Hospital Revenue Code	278
Min. Negotiated Rate	$2,613.00
Max. Negotiated Rate	$4,215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,484.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,215.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,613.00

TRAY UMBILICAL VESSEL 3.5/5FR

Facility

$312.69

Hospital Charge Code	270649899
Hospital Revenue Code	272
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$156.34
Rate for Payer: Aetna Commercial	$93.81
Rate for Payer: Aetna Medicare Advantage	$93.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.74
Rate for Payer: Cigna Commercial	$156.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.65
Rate for Payer: Oxford Commercial	$156.34
Rate for Payer: Qualcare PPO/HMO/WC	$46.90
Rate for Payer: UnitedHealthcare Commercial	$156.34

TRAY UMBILICAL VESSEL 3.5/5FR

Facility

$312.69

Hospital Charge Code	270649899
Hospital Revenue Code	272
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$46.90
Rate for Payer: Qualcare PPO/HMO/WC	$46.90

TRAY UNIVERSAL L FACET 18153

Facility

$54.75

Hospital Charge Code	270632600
Hospital Revenue Code	272
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$8.21
Rate for Payer: Qualcare PPO/HMO/WC	$8.21

TRAY UNIVERSAL L FACET 18153

Facility

$54.75

Hospital Charge Code	270632600
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$27.38
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$16.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.96
Rate for Payer: Cigna Commercial	$27.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.12
Rate for Payer: Oxford Commercial	$27.38
Rate for Payer: Qualcare PPO/HMO/WC	$8.21
Rate for Payer: UnitedHealthcare Commercial	$27.38

TRAY URETHRAL

Facility

$1,266.45

Hospital Charge Code	270679643
Hospital Revenue Code	272
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$633.23
Rate for Payer: Aetna Commercial	$379.94
Rate for Payer: Aetna Medicare Advantage	$379.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.94
Rate for Payer: Cigna Commercial	$633.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.64
Rate for Payer: Oxford Commercial	$633.23
Rate for Payer: Qualcare PPO/HMO/WC	$189.97
Rate for Payer: UnitedHealthcare Commercial	$633.23

TRAY URETHRAL

Facility

$1,266.45

Hospital Charge Code	270679643
Hospital Revenue Code	272
Min. Negotiated Rate	$189.97
Max. Negotiated Rate	$189.97
Rate for Payer: Qualcare PPO/HMO/WC	$189.97

TRAY URETHRAL CATH 14FR

Facility

$8.30

Hospital Charge Code	270650179
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

TRAY URETHRAL CATH 14FR

Facility

$8.30

Hospital Charge Code	270650179
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$2.49
Rate for Payer: Aetna Medicare Advantage	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.12
Rate for Payer: Cigna Commercial	$4.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.08
Rate for Payer: Oxford Commercial	$4.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$4.15

TRAY URETHRL W/STR CATH 772414

Facility

$11.82

Hospital Charge Code	270302232
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$5.91
Rate for Payer: Aetna Commercial	$3.55
Rate for Payer: Aetna Medicare Advantage	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.54
Rate for Payer: Oxford Commercial	$5.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$5.91

TRAY URETHRL W/STR CATH 772414

Facility

$11.82

Hospital Charge Code	270302232
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

TRAY URINARY DRAINAGE W/CATH

Facility

$72.00

Hospital Charge Code	270302236
Hospital Revenue Code	272
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

TRAY URINARY DRAINAGE W/CATH

Facility

$72.00

Hospital Charge Code	270302236
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

TRAY VASCULAR

Facility

$379.50

Hospital Charge Code	270654129
Hospital Revenue Code	271
Min. Negotiated Rate	$49.34
Max. Negotiated Rate	$189.75
Rate for Payer: Aetna Commercial	$113.85
Rate for Payer: Aetna Medicare Advantage	$113.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.77
Rate for Payer: Cigna Commercial	$189.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.34
Rate for Payer: Oxford Commercial	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.92
Rate for Payer: UnitedHealthcare Commercial	$189.75

TRAY VASCULAR

Facility

$379.50

Hospital Charge Code	270654129
Hospital Revenue Code	271
Min. Negotiated Rate	$56.92
Max. Negotiated Rate	$56.92
Rate for Payer: Qualcare PPO/HMO/WC	$56.92

TRAY VENOUS CUT DOWN NON-DISP

Facility

$408.85

Hospital Charge Code	2708002438
Hospital Revenue Code	272
Min. Negotiated Rate	$53.15
Max. Negotiated Rate	$204.43
Rate for Payer: Aetna Commercial	$122.66
Rate for Payer: Aetna Medicare Advantage	$122.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.26
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.15
Rate for Payer: Oxford Commercial	$204.43
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Commercial	$204.43

TRAY VENOUS CUT DOWN NON-DISP

Facility

$408.85

Hospital Charge Code	2708002438
Hospital Revenue Code	272
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$61.33
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

TRAZADONE,150MG,TAB

Facility

$1.00

Hospital Charge Code	60635467
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

TRAZADONE,150MG,TAB

Facility

$1.00

Hospital Charge Code	60635467
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TRAZODONE 100 MG TAB

Facility

$5.63

Service Code	NDC 13668033005
Hospital Charge Code	60627783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$2.81

TRAZODONE 100 MG TAB

Facility

$5.63

Service Code	NDC 13668033005
Hospital Charge Code	60627783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

TRAZODONE 50 MG TAB

Facility

$7.17

Service Code	NDC 60505265301
Hospital Charge Code	60627784
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

TRAZODONE 50 MG TAB

Facility

$7.17

Service Code	NDC 60505265301
Hospital Charge Code	60627784
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.83
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.93
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$3.58

TRAZODONE (DESYREL)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3009818
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	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
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

TRAZODONE (DESYREL)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3009818
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

Know your out-of-pocket cost for care.

All Charges