Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIDTIIPSLCLUSTHOLEHAACESH52MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691240
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,429.50
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIDTIIPSLCLUSTHOLEHAACESH54MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691241
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$1,153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIDTIIPSLCLUSTHOLEHAACESH54MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691241
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,429.50
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

TRIETHANOLAMINE OTIC 15ML

Facility

$19.20

Hospital Charge Code	6005482
Hospital Revenue Code	252
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.88

TRIETHANOLAMINE OTIC 15ML

Facility

$19.20

Hospital Charge Code	6005482
Hospital Revenue Code	252
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna Commercial	$5.76
Rate for Payer: Aetna Medicare Advantage	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.90
Rate for Payer: Cigna Commercial	$9.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.88
Rate for Payer: UnitedHealthcare Commercial	$9.60

TRIETHYLENE THIOPHOSPHORA 15MG

Facility

$803.25

Hospital Charge Code	60627408
Hospital Revenue Code	636
Min. Negotiated Rate	$120.49
Max. Negotiated Rate	$401.62
Rate for Payer: Aetna Commercial	$240.97
Rate for Payer: Aetna Medicare Advantage	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.83
Rate for Payer: Cigna Commercial	$401.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.39
Rate for Payer: Qualcare PPO/HMO/WC	$120.49

TRIETHYLENE THIOPHOSPHORA 15MG

Facility

$803.25

Hospital Charge Code	60627408
Hospital Revenue Code	636
Min. Negotiated Rate	$120.49
Max. Negotiated Rate	$194.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.39
Rate for Payer: Qualcare PPO/HMO/WC	$120.49

TRIFLUOPERAZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634071
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

TRIFLUOPERAZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIFLUOPERAZINE 1 MG TAB

Facility

$4.85

Hospital Charge Code	60627831
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

TRIFLUOPERAZINE 1 MG TAB

Facility

$4.85

Hospital Charge Code	60627831
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIFLUOPERAZINE/1MG/TAB

Facility

$6.03

Service Code	NDC 51079057201
Hospital Charge Code	60634068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.02

TRIFLUOPERAZINE/1MG/TAB

Facility

$6.03

Service Code	NDC 51079057201
Hospital Charge Code	60634068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TRIFLUOPERAZINE 20 MG/10ML INJ

Facility

$400.00

Hospital Charge Code	60627832
Hospital Revenue Code	250
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$200.00

TRIFLUOPERAZINE 20 MG/10ML INJ

Facility

$400.00

Hospital Charge Code	60627832
Hospital Revenue Code	250
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

TRIFLUOPERAZINE 2 MG TAB

Facility

$7.25

Hospital Charge Code	60627833
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

TRIFLUOPERAZINE 2 MG TAB

Facility

$7.25

Hospital Charge Code	60627833
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

TRIFLUOPERAZINE/2MG/TAB

Facility

$3.00

Hospital Charge Code	60634069
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

TRIFLUOPERAZINE/2MG/TAB

Facility

$3.00

Hospital Charge Code	60634069
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIFLUOPERAZINE 5 MG TAB

Facility

$9.65

Hospital Charge Code	60627834
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

TRIFLUOPERAZINE 5 MG TAB

Facility

$9.65

Hospital Charge Code	60627834
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

TRIFLUOPERAZINE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634070
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

TRIFLUOPERAZINE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634070
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIFLUOPERAZINE HCL CONC.

Facility

$75.00

Hospital Charge Code	60634889
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

TRIFLUOPERAZINE HCL CONC.

Facility

$75.00

Hospital Charge Code	60634889
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

Know your out-of-pocket cost for care.

All Charges