Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIFLUOPERAZINE HYDROCHLORID 1

Facility

$16.42

Service Code	NDC 378241001
Hospital Charge Code	6063943257
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$8.21
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: Aetna Medicare Advantage	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.19
Rate for Payer: Cigna Commercial	$8.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.13
Rate for Payer: Oxford Commercial	$8.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$8.21

TRIFLUOPERAZINE HYDROCHLORID 1

Facility

$16.42

Service Code	NDC 378241001
Hospital Charge Code	6063943257
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

TRIFLUOPERAZINE HYDROCHLORID 5

Facility

$10.85

Service Code	NDC 378240501
Hospital Charge Code	6063943258
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.63

TRIFLUOPERAZINE HYDROCHLORID 5

Facility

$10.85

Service Code	NDC 378240501
Hospital Charge Code	6063943258
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$5.42
Rate for Payer: Aetna Commercial	$3.25
Rate for Payer: Aetna Medicare Advantage	$3.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.77
Rate for Payer: Cigna Commercial	$5.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.41
Rate for Payer: Oxford Commercial	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.63
Rate for Payer: UnitedHealthcare Commercial	$5.42

TRIFLUOPERAZINE LQ 10MG/ML 60M

Facility

$285.45

Hospital Charge Code	6005490
Hospital Revenue Code	251
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$42.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.82

TRIFLUOPERAZINE LQ 10MG/ML 60M

Facility

$285.45

Hospital Charge Code	6005490
Hospital Revenue Code	251
Min. Negotiated Rate	$37.11
Max. Negotiated Rate	$142.72
Rate for Payer: Aetna Commercial	$85.64
Rate for Payer: Aetna Medicare Advantage	$85.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.79
Rate for Payer: Cigna Commercial	$142.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.11
Rate for Payer: Oxford Commercial	$142.72
Rate for Payer: Qualcare PPO/HMO/WC	$42.82
Rate for Payer: UnitedHealthcare Commercial	$142.72

TRIFLUOPERAZINE TAB 10MG

Facility

$9.00

Hospital Charge Code	60627830
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

TRIFLUOPERAZINE TAB 10MG

Facility

$9.00

Hospital Charge Code	60627830
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TRIFLURIDINE SOL OPH 1%

Facility

$1,768.13

Service Code	NDC 61570003775
Hospital Charge Code	60628026
Hospital Revenue Code	250
Min. Negotiated Rate	$229.86
Max. Negotiated Rate	$884.07
Rate for Payer: Aetna Commercial	$530.44
Rate for Payer: Aetna Medicare Advantage	$530.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.87
Rate for Payer: Cigna Commercial	$884.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.86
Rate for Payer: Oxford Commercial	$884.07
Rate for Payer: Qualcare PPO/HMO/WC	$265.22
Rate for Payer: UnitedHealthcare Commercial	$884.07

TRIFLURIDINE SOL OPH 1%

Facility

$1,768.13

Service Code	NDC 61570003775
Hospital Charge Code	60628026
Hospital Revenue Code	250
Min. Negotiated Rate	$265.22
Max. Negotiated Rate	$265.22
Rate for Payer: Qualcare PPO/HMO/WC	$265.22

TRIFLURIDINE SOL OPH 1% 7.5ML

Facility

$317.45

Hospital Charge Code	6005508
Hospital Revenue Code	252
Min. Negotiated Rate	$47.62
Max. Negotiated Rate	$47.62
Rate for Payer: Qualcare PPO/HMO/WC	$47.62

TRIFLURIDINE SOL OPH 1% 7.5ML

Facility

$317.45

Hospital Charge Code	6005508
Hospital Revenue Code	252
Min. Negotiated Rate	$41.27
Max. Negotiated Rate	$158.72
Rate for Payer: Aetna Commercial	$95.23
Rate for Payer: Aetna Medicare Advantage	$95.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.95
Rate for Payer: Cigna Commercial	$158.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.27
Rate for Payer: Oxford Commercial	$158.72
Rate for Payer: Qualcare PPO/HMO/WC	$47.62
Rate for Payer: UnitedHealthcare Commercial	$158.72

TRIGGER FLEX

Facility

$2,975.00

Hospital Charge Code	270674917
Hospital Revenue Code	272
Min. Negotiated Rate	$386.75
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$892.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.75
Rate for Payer: Oxford Commercial	$1,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$1,487.50

TRIGGER FLEX

Facility

$2,975.00

Hospital Charge Code	270674917
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

TRIGGER FLEX

Facility

$2,475.00

Hospital Charge Code	270691475
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

TRIGGER FLEX

Facility

$2,475.00

Hospital Charge Code	270691475
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.75
Rate for Payer: Oxford Commercial	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$1,237.50

TRIGGER POINT INJECTION****

Facility

$180.00

Service Code	HCPCS 20550
Hospital Charge Code	1001125
Hospital Revenue Code	361
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TRIGGER POINT INJECTION****

Facility

$180.00

Service Code	HCPCS 20550
Hospital Charge Code	1001125
Hospital Revenue Code	361
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

TRIGLYCERIDE,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	3002610
Hospital Revenue Code	301
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.60
Rate for Payer: Aetna Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.03
Rate for Payer: Cigna Commercial	$5.74
Rate for Payer: Cigna Medicare Advantage	$2.87
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
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	$5.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.08
Rate for Payer: Wellcare Medicare Advantage	$5.74

TRIGLYCERIDE,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	3002610
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRIGLYCERIDE, PLEURAL FLUID

Facility

$77.65

Service Code	HCPCS 84478
Hospital Charge Code	3002611
Hospital Revenue Code	301
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.60
Rate for Payer: Aetna Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.03
Rate for Payer: Cigna Commercial	$5.74
Rate for Payer: Cigna Medicare Advantage	$2.87
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.08
Rate for Payer: Wellcare Medicare Advantage	$5.74

TRIGLYCERIDE, PLEURAL FLUID

Facility

$77.65

Service Code	HCPCS 84478
Hospital Charge Code	3002611
Hospital Revenue Code	301
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

TRIGLYCERIDES

Facility

$8.10

Service Code	HCPCS 84478CF
Hospital Charge Code	8200332RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.22

TRIGLYCERIDES

Facility

$8.10

Service Code	HCPCS 84478CF
Hospital Charge Code	8200332RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$2.43
Rate for Payer: Aetna Medicare Advantage	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.07
Rate for Payer: Cigna Commercial	$4.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.22
Rate for Payer: UnitedHealthcare Commercial	$114.00

TRIGLYCERIDES

Facility

$306.00

Service Code	HCPCS 84478
Hospital Charge Code	38472654
Hospital Revenue Code	301
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.60
Rate for Payer: Aetna Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.03
Rate for Payer: Cigna Commercial	$5.74
Rate for Payer: Cigna Medicare Advantage	$2.87
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.08
Rate for Payer: Wellcare Medicare Advantage	$5.74

Know your out-of-pocket cost for care.

All Charges