Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIMETHOPRIM/100MG/PO/TAB

Facility

$3.00

Hospital Charge Code	60634948
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

TRIMETHOPRIM/100MG/PO/TAB

Facility

$3.00

Hospital Charge Code	60634948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIMETREXATE 25 MG INJ

Facility

$882.75

Hospital Charge Code	60629002
Hospital Revenue Code	636
Min. Negotiated Rate	$132.41
Max. Negotiated Rate	$441.38
Rate for Payer: Aetna Commercial	$264.82
Rate for Payer: Aetna Medicare Advantage	$264.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.10
Rate for Payer: Cigna Commercial	$441.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.63
Rate for Payer: Qualcare PPO/HMO/WC	$132.41

TRIMETREXATE 25 MG INJ

Facility

$882.75

Hospital Charge Code	60629002
Hospital Revenue Code	636
Min. Negotiated Rate	$132.41
Max. Negotiated Rate	$213.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.63
Rate for Payer: Qualcare PPO/HMO/WC	$132.41

TRIM FIX NAIL 4X100MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

TRIM FIX NAIL 4X100MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$4,875.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

TRIMING BLADES LONG

Facility

$43.10

Hospital Charge Code	270665508
Hospital Revenue Code	272
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$6.46
Rate for Payer: Qualcare PPO/HMO/WC	$6.46

TRIMING BLADES LONG

Facility

$43.10

Hospital Charge Code	270665508
Hospital Revenue Code	272
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$21.55
Rate for Payer: Aetna Commercial	$12.93
Rate for Payer: Aetna Medicare Advantage	$12.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.99
Rate for Payer: Cigna Commercial	$21.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.60
Rate for Payer: Oxford Commercial	$21.55
Rate for Payer: Qualcare PPO/HMO/WC	$6.46
Rate for Payer: UnitedHealthcare Commercial	$21.55

TRIMIPRAMINE CAP 25MG

Facility

$5.80

Hospital Charge Code	60628731
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

TRIMIPRAMINE CAP 25MG

Facility

$5.80

Hospital Charge Code	60628731
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

TRIM IT PINS 1.5MMX100MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270653041
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRIM IT PINS 1.5MMX100MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270653041
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRIM IT PINS 2.0

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270691911
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRIM IT PINS 2.0

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270691911
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRIM NAILS

Facility

$327.35

Service Code	HCPCS 11719
Hospital Charge Code	5770005
Hospital Revenue Code	450
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$49.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.10

TRIM NAILS

Facility

$327.35

Service Code	HCPCS 11719
Hospital Charge Code	5770005
Hospital Revenue Code	450
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$98.20
Rate for Payer: Aetna Medicare Advantage	$98.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.47
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.56
Rate for Payer: Qualcare PPO/HMO/WC	$49.10

TRIM NAIL(S) ANY NUMBER

Facility

$328.10

Service Code	HCPCS 11719
Hospital Charge Code	412311719
Hospital Revenue Code	361
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$98.43
Rate for Payer: Aetna Medicare Advantage	$98.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.67
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	$83.67
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.65
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.22
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TRIM NAIL(S) ANY NUMBER

Facility

$328.10

Service Code	HCPCS 11719
Hospital Charge Code	412311719
Hospital Revenue Code	361
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$49.22
Rate for Payer: Qualcare PPO/HMO/WC	$49.22

TRIMOX 125/125MG/5ML

Facility

$3.00

Hospital Charge Code	60634078
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIMOX 125/125MG/5ML

Facility

$13.00

Hospital Charge Code	60634081
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

TRIMOX 125/125MG/5ML

Facility

$13.00

Hospital Charge Code	60634080
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

TRIMOX 125/125MG/5ML

Facility

$13.00

Hospital Charge Code	60634080
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

TRIMOX 125/125MG/5ML

Facility

$9.00

Hospital Charge Code	60634079
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

TRIMOX 125/125MG/5ML

Facility

$9.00

Hospital Charge Code	60634079
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TRIMOX 125/125MG/5ML

Facility

$13.00

Hospital Charge Code	60634081
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

Know your out-of-pocket cost for care.

All Charges