Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIPLE SCREEN III

Facility

$390.00

Service Code	HCPCS 84702
Hospital Charge Code	39990062C
Hospital Revenue Code	301
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
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	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

TRIPLE SULFA VAGINAL/78GM

Facility

$18.00

Hospital Charge Code	60634093
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

TRIPLE SULFA VAGINAL/78GM

Facility

$23.00

Hospital Charge Code	60634094
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

TRIPLE SULFA VAGINAL/78GM

Facility

$18.00

Hospital Charge Code	60634093
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TRIPLE SULFA VAGINAL/78GM

Facility

$23.00

Hospital Charge Code	60634094
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

TRIPLE SULFA VAGINAL CREAM

Facility

$2.45

Hospital Charge Code	6006480
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

TRIPLE SULFA VAGINAL CREAM

Facility

$2.45

Hospital Charge Code	6006480
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TRIPROL LQ 1.25MG PSEUD 30MG

Facility

$52.50

Hospital Charge Code	6010060
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

TRIPROL LQ 1.25MG PSEUD 30MG

Facility

$52.50

Hospital Charge Code	6010060
Hospital Revenue Code	251
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

TRIPROL PSEUDOEPH 1.25 30MG 5M

Facility

$17.95

Hospital Charge Code	60627234
Hospital Revenue Code	251
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

TRIPROL PSEUDOEPH 1.25 30MG 5M

Facility

$17.95

Hospital Charge Code	60627234
Hospital Revenue Code	251
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

TRIPROL PSEUDOEPH COD LQ 16 OZ

Facility

$309.15

Hospital Charge Code	6005532
Hospital Revenue Code	251
Min. Negotiated Rate	$46.37
Max. Negotiated Rate	$46.37
Rate for Payer: Qualcare PPO/HMO/WC	$46.37

TRIPROL PSEUDOEPH COD LQ 16 OZ

Facility

$309.15

Hospital Charge Code	6005532
Hospital Revenue Code	251
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$154.57
Rate for Payer: Aetna Commercial	$92.75
Rate for Payer: Aetna Medicare Advantage	$92.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.83
Rate for Payer: Cigna Commercial	$154.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.19
Rate for Payer: Oxford Commercial	$154.57
Rate for Payer: Qualcare PPO/HMO/WC	$46.37
Rate for Payer: UnitedHealthcare Commercial	$154.57

TRIPROL PSEUDOEPH TAB 2.5-60MG

Facility

$2.45

Hospital Charge Code	60627473
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

TRIPROL PSEUDOEPH TAB 2.5-60MG

Facility

$2.45

Hospital Charge Code	60627473
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TRIPSLHACLUSACETSH56MMALPHA F

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270691176
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

TRIPSLHACLUSACETSH56MMALPHA F

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270691176
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$2,367.35
Rate for Payer: Aetna Commercial	$1,420.41
Rate for Payer: Aetna Medicare Advantage	$1,420.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.35
Rate for Payer: Cigna Commercial	$2,367.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

TRITANIUM CLUS HOLE SHELL 54MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270676576
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRITANIUM CLUS HOLE SHELL 54MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270676576
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRITANIUM CLUS HOLE SHELL 62MM

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671847
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

TRITANIUM CLUS HOLE SHELL 62MM

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671847
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

TRITOME TRIPLE EDGE

Facility

$2,725.00

Hospital Charge Code	270697199
Hospital Revenue Code	272
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$408.75
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

TRITOME TRIPLE EDGE

Facility

$2,725.00

Hospital Charge Code	270697199
Hospital Revenue Code	272
Min. Negotiated Rate	$354.25
Max. Negotiated Rate	$1,362.50
Rate for Payer: Aetna Commercial	$817.50
Rate for Payer: Aetna Medicare Advantage	$817.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.88
Rate for Payer: Cigna Commercial	$1,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.25
Rate for Payer: Oxford Commercial	$1,362.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75
Rate for Payer: UnitedHealthcare Commercial	$1,362.50

TRIVEX 100SV RESECTOR KIT

Facility

$613.00

Hospital Charge Code	270339009
Hospital Revenue Code	272
Min. Negotiated Rate	$79.69
Max. Negotiated Rate	$306.50
Rate for Payer: Aetna Commercial	$183.90
Rate for Payer: Aetna Medicare Advantage	$183.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.31
Rate for Payer: Cigna Commercial	$306.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.69
Rate for Payer: Oxford Commercial	$306.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.95
Rate for Payer: UnitedHealthcare Commercial	$306.50

TRIVEX 100SV RESECTOR KIT

Facility

$613.00

Hospital Charge Code	270339009
Hospital Revenue Code	272
Min. Negotiated Rate	$91.95
Max. Negotiated Rate	$91.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.95

Know your out-of-pocket cost for care.

All Charges