Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIAVIL 4-25/TAB

Facility

$5.00

Hospital Charge Code	60634063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TRIAVIL 4-25/TAB

Facility

$5.00

Hospital Charge Code	60634063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

TRIAVIL 4-50/TAB

Facility

$6.00

Hospital Charge Code	60634064
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

TRIAVIL 4-50/TAB

Facility

$6.00

Hospital Charge Code	60634064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TRIAZOLAM 0.125MG

Facility

$4.50

Hospital Charge Code	6011142
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

TRIAZOLAM 0.125MG

Facility

$4.50

Hospital Charge Code	6011142
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

TRIAZOLAM 0.25MG

Facility

$4.50

Hospital Charge Code	6011159
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

TRIAZOLAM 0.25MG

Facility

$4.50

Hospital Charge Code	6011159
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

TRIAZOLAM TAB 0.125MG

Facility

$5.65

Hospital Charge Code	60627852
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

TRIAZOLAM TAB 0.125MG

Facility

$5.65

Hospital Charge Code	60627852
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
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	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

TRIAZOLAM TAB 0.25MG

Facility

$4.50

Hospital Charge Code	60627853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

TRIAZOLAM TAB 0.25MG

Facility

$4.50

Hospital Charge Code	60627853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

TRICHINELLA AB IGG ELISA SERUM

Facility

$182.23

Service Code	HCPCS 86784
Hospital Charge Code	401386784
Hospital Revenue Code	302
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$27.33
Rate for Payer: Qualcare PPO/HMO/WC	$27.33

TRICHINELLA AB IGG ELISA SERUM

Facility

$182.23

Service Code	HCPCS 86784
Hospital Charge Code	401386784
Hospital Revenue Code	302
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.69
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.02
Rate for Payer: Cigna Commercial	$12.56
Rate for Payer: Cigna Medicare Advantage	$6.28
Rate for Payer: Clover Medicare Advantage	$11.93
Rate for Payer: EmblemHealth Commercial	$37.68
Rate for Payer: Humana Medicare Advantage	$12.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.33
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.31
Rate for Payer: Wellcare Medicare Advantage	$12.56

TRICHINELLA ANTIBODY

Facility

$136.00

Service Code	HCPCS 86784
Hospital Charge Code	38476213
Hospital Revenue Code	302
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.69
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.02
Rate for Payer: Cigna Commercial	$12.56
Rate for Payer: Cigna Medicare Advantage	$6.28
Rate for Payer: Clover Medicare Advantage	$11.93
Rate for Payer: EmblemHealth Commercial	$37.68
Rate for Payer: Humana Medicare Advantage	$12.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.31
Rate for Payer: Wellcare Medicare Advantage	$12.56

TRICHINELLA ANTIBODY

Facility

$346.45

Service Code	HCPCS 86784
Hospital Charge Code	3009529
Hospital Revenue Code	302
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.69
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.02
Rate for Payer: Cigna Commercial	$12.56
Rate for Payer: Cigna Medicare Advantage	$6.28
Rate for Payer: Clover Medicare Advantage	$11.93
Rate for Payer: EmblemHealth Commercial	$37.68
Rate for Payer: Humana Medicare Advantage	$12.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.31
Rate for Payer: Wellcare Medicare Advantage	$12.56

TRICHINELLA ANTIBODY

Facility

$136.00

Service Code	HCPCS 86784
Hospital Charge Code	38476213
Hospital Revenue Code	302
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

TRICHINELLA ANTIBODY

Facility

$346.45

Service Code	HCPCS 86784
Hospital Charge Code	3009529
Hospital Revenue Code	302
Min. Negotiated Rate	$51.97
Max. Negotiated Rate	$51.97
Rate for Payer: Qualcare PPO/HMO/WC	$51.97

TRICHINELLA IGG AB,ELISA (SERU

Facility

$123.05

Service Code	HCPCS 86784
Hospital Charge Code	397080019
Hospital Revenue Code	302
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.69
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.02
Rate for Payer: Cigna Commercial	$12.56
Rate for Payer: Cigna Medicare Advantage	$6.28
Rate for Payer: Clover Medicare Advantage	$11.93
Rate for Payer: EmblemHealth Commercial	$37.68
Rate for Payer: Humana Medicare Advantage	$12.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.46
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.31
Rate for Payer: Wellcare Medicare Advantage	$12.56

TRICHINELLA IGG AB,ELISA (SERU

Facility

$123.05

Service Code	HCPCS 86784
Hospital Charge Code	397080019
Hospital Revenue Code	302
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.46

TRICHOMONAS VAGINALIS AMPLIF

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	3990245B
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
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	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

TRICHOMONAS VAGINALIS AMPLIF

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	3990245B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRICHOMONAS VAG RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	38479745
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRICHOMONAS VAG RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87661
Hospital Charge Code	38479745
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
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	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

TRICHOPHYTON INJ 1:500W/V

Facility

$22.45

Hospital Charge Code	60628947
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

Know your out-of-pocket cost for care.

All Charges