Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRICHOPHYTON INJ 1:500W/V

Facility

$22.45

Hospital Charge Code	60628947
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$11.22

TRICHOPHYTON MENTAGROPHYT

Facility

$19.03

Service Code	NDC 268043202
Hospital Charge Code	60634535
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.52
Rate for Payer: Aetna Commercial	$5.71
Rate for Payer: Aetna Medicare Advantage	$5.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.85
Rate for Payer: Cigna Commercial	$9.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.52

TRICHOPHYTON MENTAGROPHYT

Facility

$19.03

Service Code	NDC 268043202
Hospital Charge Code	60634535
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

TRICHROME STAIN

Facility

$244.00

Service Code	HCPCS 87209
Hospital Charge Code	38475089
Hospital Revenue Code	309
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

TRICHROME STAIN

Facility

$244.00

Service Code	HCPCS 87209
Hospital Charge Code	38475089
Hospital Revenue Code	309
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

TRICOR 145 MG TAB

Facility

$14.10

Hospital Charge Code	60629829
Hospital Revenue Code	251
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$7.05
Rate for Payer: Aetna Commercial	$4.23
Rate for Payer: Aetna Medicare Advantage	$4.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.60
Rate for Payer: Cigna Commercial	$7.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.83
Rate for Payer: Oxford Commercial	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.12
Rate for Payer: UnitedHealthcare Commercial	$7.05

TRICOR 145 MG TAB

Facility

$14.10

Hospital Charge Code	60629829
Hospital Revenue Code	251
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.12

TRICOR,160MG,TAB

Facility

$4.00

Hospital Charge Code	60635458
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

TRICOR,160MG,TAB

Facility

$4.00

Hospital Charge Code	60635458
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TRICOR 48 MG TAB

Facility

$4.65

Hospital Charge Code	60629828
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

TRICOR 48 MG TAB

Facility

$4.65

Hospital Charge Code	60629828
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2.33
Rate for Payer: Aetna Commercial	$1.40
Rate for Payer: Aetna Medicare Advantage	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.19
Rate for Payer: Cigna Commercial	$2.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$2.33

TRICOR,54MG,TAB

Facility

$2.00

Hospital Charge Code	60635457
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

TRICOR,54MG,TAB

Facility

$2.00

Hospital Charge Code	60635457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TRI CRU RETAIN FEM SZ 1 LT CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697570
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

TRI CRU RETAIN FEM SZ 1 LT CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697570
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

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	3039018
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	38430018
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	3039018
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	39990218
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	39990218
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	38430018
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRIDENT 0 DEG INSERT 40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697216
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$2,217.12
Rate for Payer: Aetna Commercial	$1,330.28
Rate for Payer: Aetna Medicare Advantage	$1,330.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,130.73
Rate for Payer: Cigna Commercial	$2,217.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

TRIDENT 0 DEG INSERT 40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697216
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$1,073.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

TRIDENT 10 X 3 INSERT 36MM ID

Facility

$5,146.35

Service Code	HCPCS C1776
Hospital Charge Code	270681085
Hospital Revenue Code	278
Min. Negotiated Rate	$771.95
Max. Negotiated Rate	$2,573.18
Rate for Payer: Aetna Commercial	$1,543.90
Rate for Payer: Aetna Medicare Advantage	$1,543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.32
Rate for Payer: Cigna Commercial	$2,573.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.42
Rate for Payer: Qualcare PPO/HMO/WC	$771.95

TRIDENT 10 X 3 INSERT 36MM ID

Facility

$5,146.35

Service Code	HCPCS C1776
Hospital Charge Code	270681085
Hospital Revenue Code	278
Min. Negotiated Rate	$771.95
Max. Negotiated Rate	$1,245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.42
Rate for Payer: Qualcare PPO/HMO/WC	$771.95

Know your out-of-pocket cost for care.

All Charges