Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRILAFON/8MG/TAB

Facility

$3.00

Hospital Charge Code	60634073
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRILAFON/8MG/TAB

Facility

$3.00

Hospital Charge Code	60634073
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

TRILAFON CONC/118ML

Facility

$26.13

Service Code	NDC 781804901
Hospital Charge Code	60634591
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$13.06
Rate for Payer: Aetna Commercial	$7.84
Rate for Payer: Aetna Medicare Advantage	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.66
Rate for Payer: Cigna Commercial	$13.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.40
Rate for Payer: Oxford Commercial	$13.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.92
Rate for Payer: UnitedHealthcare Commercial	$13.06

TRILAFON CONC/118ML

Facility

$26.13

Service Code	NDC 781804901
Hospital Charge Code	60634591
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Qualcare PPO/HMO/WC	$3.92

TRILEPTAL

Facility

$124.10

Service Code	HCPCS 83789
Hospital Charge Code	39900429
Hospital Revenue Code	301
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

TRILEPTAL

Facility

$124.10

Service Code	HCPCS 83789
Hospital Charge Code	39900429
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.12
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.34
Rate for Payer: Cigna Commercial	$24.11
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.61
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.56
Rate for Payer: Wellcare Medicare Advantage	$24.11

TRILEPTAL 150MG TAB

Facility

$2.00

Hospital Charge Code	60635410
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

TRILEPTAL 150MG TAB

Facility

$2.00

Hospital Charge Code	60635410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TRILEPTAL 600 MG TAB

Facility

$34.30

Service Code	NDC 54009920
Hospital Charge Code	60635626
Hospital Revenue Code	250
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$17.15
Rate for Payer: Aetna Commercial	$10.29
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.75
Rate for Payer: Cigna Commercial	$17.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.46
Rate for Payer: Oxford Commercial	$17.15
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$17.15

TRILEPTAL 600 MG TAB

Facility

$34.30

Service Code	NDC 54009920
Hospital Charge Code	60635626
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

TRILEPTAL 600MG TAB

Facility

$25.00

Hospital Charge Code	60635628
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

TRILEPTAL 600MG TAB

Facility

$25.00

Hospital Charge Code	60635628
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

TRILEPTAL LEVEL(OXCARBA*******

Facility

$289.00

Service Code	HCPCS 82491
Hospital Charge Code	3002584
Hospital Revenue Code	301
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$144.50
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare Advantage	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.69
Rate for Payer: Cigna Commercial	$144.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

TRILEPTAL LEVEL(OXCARBA*******

Facility

$289.00

Service Code	HCPCS 82491
Hospital Charge Code	3002584
Hospital Revenue Code	301
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$43.35
Rate for Payer: Qualcare PPO/HMO/WC	$43.35

TRI-LEVLEN 21/TAB

Facility

$18.00

Hospital Charge Code	60634057
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TRI-LEVLEN 21/TAB

Facility

$18.00

Hospital Charge Code	60634057
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

TRIL-EXPRESS 300C 2.5CC

Facility

$4,250.00

Hospital Charge Code	270657191
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

TRIL-EXPRESS 300C 2.5CC

Facility

$4,250.00

Hospital Charge Code	270657191
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

TRILISATE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60634075
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRILISATE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60634075
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

TRILISATE/750MG/TAB

Facility

$3.00

Hospital Charge Code	60634076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRILISATE/750MG/TAB

Facility

$3.00

Hospital Charge Code	60634074
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

TRILISATE/750MG/TAB

Facility

$3.00

Hospital Charge Code	60634076
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

TRILISATE/750MG/TAB

Facility

$3.00

Hospital Charge Code	60634074
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIMED IV FILTER **********

Facility

$8.00

Hospital Charge Code	7000805
Hospital Revenue Code	279
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

Know your out-of-pocket cost for care.

All Charges