Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIAMCNOLNE ACET INH 100MG/PFF

Facility

$109.45

Hospital Charge Code	6005425
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$3.85

Hospital Charge Code	6023154
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$3.85

Hospital Charge Code	6023154
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$4.00

Service Code	NDC 51079093501
Hospital Charge Code	6023410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$4.00

Service Code	NDC 51079093501
Hospital Charge Code	6023410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

TRIAMTERENE 50 MG CAP

Facility

$30.55

Service Code	NDC 59212000201
Hospital Charge Code	6063943256
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$15.28
Rate for Payer: Aetna Commercial	$9.16
Rate for Payer: Aetna Medicare Advantage	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.79
Rate for Payer: Cigna Commercial	$15.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.97
Rate for Payer: Oxford Commercial	$15.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.58
Rate for Payer: UnitedHealthcare Commercial	$15.28

TRIAMTERENE 50 MG CAP

Facility

$30.55

Service Code	NDC 59212000201
Hospital Charge Code	6063943256
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$4.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.58

TRIAMTERENE CAP 100MG

Facility

$4.85

Hospital Charge Code	60627977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

TRIAMTERENE CAP 100MG

Facility

$4.85

Hospital Charge Code	60627977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIAMTERENE CAP 50MG

Facility

$4.00

Hospital Charge Code	60627978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TRIAMTERENE CAP 50MG

Facility

$4.00

Hospital Charge Code	60627978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

TRIAMTERENE-HCTZ TAB 37.5-25MG

Facility

$4.85

Hospital Charge Code	60628833
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

TRIAMTERENE-HCTZ TAB 37.5-25MG

Facility

$4.85

Hospital Charge Code	60628833
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIAMTERENE HCTZ TAB 75-50MG

Facility

$12.55

Hospital Charge Code	60627979
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna Medicare Advantage	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.63
Rate for Payer: Oxford Commercial	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$6.28

TRIAMTERENE HCTZ TAB 75-50MG

Facility

$12.55

Hospital Charge Code	60627979
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

TRIATHALONCR FEM COMP#7 R-CEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.93
Max. Negotiated Rate	$3,923.10
Rate for Payer: Aetna Commercial	$2,353.86
Rate for Payer: Aetna Medicare Advantage	$2,353.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.78
Rate for Payer: Cigna Commercial	$3,923.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93

TRIATHALONCR FEM COMP#7 R-CEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.93
Max. Negotiated Rate	$1,898.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93

TRIATHALON CRUCIATE RETAIN FEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.93
Max. Negotiated Rate	$1,898.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93

TRIATHALON CRUCIATE RETAIN FEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.93
Max. Negotiated Rate	$3,923.10
Rate for Payer: Aetna Commercial	$2,353.86
Rate for Payer: Aetna Medicare Advantage	$2,353.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.78
Rate for Payer: Cigna Commercial	$3,923.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93

TRIATH CR FEM COMP BD SZ3 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270693337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$3,158.84
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH CR FEM COMP BD SZ3 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270693337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH CR FEM COMP B RT CR SZ2

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270693813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$5,264.75
Rate for Payer: Aetna Commercial	$3,158.85
Rate for Payer: Aetna Medicare Advantage	$3,158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.02
Rate for Payer: Cigna Commercial	$5,264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH CR FEM COMP B RT CR SZ2

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270693813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH FEM DIST AUG RT SZ4 5MM

Facility

$7,780.50

Service Code	HCPCS C1776
Hospital Charge Code	270697478
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.08
Max. Negotiated Rate	$1,882.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.08

TRIATH FEM DIST AUG RT SZ4 5MM

Facility

$7,780.50

Service Code	HCPCS C1776
Hospital Charge Code	270697478
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.08
Max. Negotiated Rate	$3,890.25
Rate for Payer: Aetna Commercial	$2,334.15
Rate for Payer: Aetna Medicare Advantage	$2,334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,984.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,984.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,984.03
Rate for Payer: Cigna Commercial	$3,890.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.08

Know your out-of-pocket cost for care.

All Charges