Heights University Hospital

All Charges

Charge

Type

Setting

Price

TREXAN/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634404
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

TRIAL ADAPTER 12 14 4MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696891
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

TRIAL ADAPTER 12 14 4MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696891
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

TRIAL KIT SPECTRA PATIENT

Facility

$575.00

Hospital Charge Code	270673089
Hospital Revenue Code	272
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

TRIAL KIT SPECTRA PATIENT

Facility

$575.00

Hospital Charge Code	270673089
Hospital Revenue Code	272
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Oxford Commercial	$287.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Commercial	$287.50

TRIAL LEAD KIT

Facility

$3,875.00

Hospital Charge Code	270705557
Hospital Revenue Code	279
Min. Negotiated Rate	$503.75
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,162.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.75
Rate for Payer: Oxford Commercial	$1,937.50
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Commercial	$1,937.50

TRIAL LEAD KIT

Facility

$3,875.00

Hospital Charge Code	270705557
Hospital Revenue Code	279
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$581.25
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

TRIAL LEAD LINEAR ST 70CM

Facility

$5,000.00

Service Code	HCPCS C1778
Hospital Charge Code	270673085
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TRIAL LEAD LINEAR ST 70CM

Facility

$5,000.00

Service Code	HCPCS C1778
Hospital Charge Code	270673085
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TRIAL SIMULATOR

Facility

$1,100.00

Hospital Charge Code	270703576
Hospital Revenue Code	270
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$330.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Commercial	$550.00

TRIAL SIMULATOR

Facility

$1,100.00

Hospital Charge Code	270703576
Hospital Revenue Code	270
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

TRIAMCINOLONE 0.5% 15GM

Facility

$67.74

Service Code	NDC 45802006535
Hospital Charge Code	6063943313
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$10.16

TRIAMCINOLONE 0.5% 15GM

Facility

$67.74

Service Code	NDC 45802006535
Hospital Charge Code	6063943313
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$33.87
Rate for Payer: Aetna Commercial	$20.32
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.27
Rate for Payer: Cigna Commercial	$33.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.81
Rate for Payer: Oxford Commercial	$33.87
Rate for Payer: Qualcare PPO/HMO/WC	$10.16
Rate for Payer: UnitedHealthcare Commercial	$33.87

TRIAMCINOLONE 55MCG/SPRAY 25ML

Facility

$222.75

Hospital Charge Code	60629214
Hospital Revenue Code	250
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Commercial	$66.83
Rate for Payer: Aetna Medicare Advantage	$66.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.80
Rate for Payer: Cigna Commercial	$111.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.96
Rate for Payer: Oxford Commercial	$111.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.41
Rate for Payer: UnitedHealthcare Commercial	$111.38

TRIAMCINOLONE 55MCG/SPRAY 25ML

Facility

$222.75

Hospital Charge Code	60629214
Hospital Revenue Code	250
Min. Negotiated Rate	$33.41
Max. Negotiated Rate	$33.41
Rate for Payer: Qualcare PPO/HMO/WC	$33.41

TRIAMCINOLONE ACET .025%80GM

Facility

$67.74

Service Code	NDC 45802005436
Hospital Charge Code	606390494
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$33.87
Rate for Payer: Aetna Commercial	$20.32
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.27
Rate for Payer: Cigna Commercial	$33.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.81
Rate for Payer: Oxford Commercial	$33.87
Rate for Payer: Qualcare PPO/HMO/WC	$10.16
Rate for Payer: UnitedHealthcare Commercial	$33.87

TRIAMCINOLONE ACET .025%80GM

Facility

$67.74

Service Code	NDC 45802005436
Hospital Charge Code	606390494
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$10.16

TRIAMCINOLONE ACET INJ 40MG/ML

Facility

$68.74

Service Code	HCPCS J3301
Hospital Charge Code	6005409
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$20.62
Rate for Payer: Aetna Medicare Advantage	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.53
Rate for Payer: Cigna Commercial	$0.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

TRIAMCINOLONE ACET INJ 40MG/ML

Facility

$68.74

Service Code	HCPCS J3301
Hospital Charge Code	6005409
Hospital Revenue Code	636
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$16.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

TRIAMCINOLONE ACET INJ 80MG/ML

Facility

$52.50

Hospital Charge Code	6005417
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

TRIAMCINOLONE ACET INJ 80MG/ML

Facility

$52.50

Hospital Charge Code	6005417
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

TRIAMCINOLONE ACETONIDE

Facility

$13.00

Hospital Charge Code	60634060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

TRIAMCINOLONE ACETONIDE

Facility

$37.39

Service Code	NDC 168000415
Hospital Charge Code	60634061
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$5.61
Rate for Payer: Qualcare PPO/HMO/WC	$5.61

TRIAMCINOLONE ACETONIDE

Facility

$13.00

Hospital Charge Code	60634060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

TRIAMCINOLONE ACETONIDE

Facility

$37.39

Service Code	NDC 168000415
Hospital Charge Code	60634061
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna Commercial	$11.22
Rate for Payer: Aetna Medicare Advantage	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.53
Rate for Payer: Cigna Commercial	$18.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.86
Rate for Payer: Oxford Commercial	$18.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.61
Rate for Payer: UnitedHealthcare Commercial	$18.70

Know your out-of-pocket cost for care.

All Charges