Heights University Hospital

All Charges

Charge

Type

Setting

Price

Tylenol no 2

Facility

$1.76

Hospital Charge Code	6063943297
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.26

TYLENOL NO 4

Facility

$7.44

Service Code	NDC 68084037301
Hospital Charge Code	6063943299
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

TYLENOL NO 4

Facility

$7.44

Service Code	NDC 68084037301
Hospital Charge Code	6063943299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Oxford Commercial	$3.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.72

TYLENOL PEDIATRIC/100MG/1

Facility

$7.00

Hospital Charge Code	60634106
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TYLENOL PEDIATRIC/100MG/1

Facility

$7.00

Hospital Charge Code	60634106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

TYLENOL W/CODEINE #2/TAB

Facility

$4.00

Hospital Charge Code	60634108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TYLENOL W/CODEINE #2/TAB

Facility

$3.00

Hospital Charge Code	60634109
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TYLENOL W/CODEINE #2/TAB

Facility

$3.00

Hospital Charge Code	60634109
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

TYLENOL W/CODEINE #2/TAB

Facility

$4.00

Hospital Charge Code	60634108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

TYLENOL W/CODEINE #3/TAB

Facility

$4.00

Hospital Charge Code	60634111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

TYLENOL W/CODEINE #3/TAB

Facility

$4.00

Hospital Charge Code	60634110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

TYLENOL W/CODEINE #3/TAB

Facility

$4.00

Hospital Charge Code	60634110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TYLENOL W/CODEINE #3/TAB

Facility

$4.00

Hospital Charge Code	60634111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TYLENOL W/CODEINE/473ML

Facility

$3.00

Hospital Charge Code	60634107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TYLENOL W/CODEINE/473ML

Facility

$3.00

Hospital Charge Code	60634107
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

TYLENOL W/CODEINE #4/TAB

Facility

$4.00

Hospital Charge Code	60634112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

TYLENOL W/CODEINE #4/TAB

Facility

$3.00

Hospital Charge Code	60634113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TYLENOL W/CODEINE #4/TAB

Facility

$3.00

Hospital Charge Code	60634113
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

TYLENOL W/CODEINE #4/TAB

Facility

$4.00

Hospital Charge Code	60634112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TYMPANOSTOMY GEN ANESTHESIA

Facility

$25,686.48

Service Code	HCPCS 69436
Hospital Charge Code	16001047
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,705.94
Rate for Payer: Aetna Commercial	$7,705.94
Rate for Payer: Aetna Medicare Advantage	$7,705.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,550.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,550.05
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	$6,550.05
Rate for Payer: Cigna Commercial	$3,694.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,339.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,852.97
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

TYMPANOSTOMY GEN ANESTHESIA

Facility

$25,686.48

Service Code	HCPCS 69436
Hospital Charge Code	16001047
Hospital Revenue Code	360
Min. Negotiated Rate	$3,852.97
Max. Negotiated Rate	$3,852.97
Rate for Payer: Qualcare PPO/HMO/WC	$3,852.97

TYPE AND CROSSMATCH AUTOLOGOUS

Facility

$100.00

Service Code	HCPCS 86920
Hospital Charge Code	3100336
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

TYPE AND CROSSMATCH AUTOLOGOUS

Facility

$100.00

Service Code	HCPCS 86920
Hospital Charge Code	3100336
Hospital Revenue Code	300
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

TYPE AND CROSS MATCH PANEL

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100583
Hospital Revenue Code	300
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$66.25
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$114.00

TYPE AND CROSS MATCH PANEL

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100583
Hospital Revenue Code	300
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

Know your out-of-pocket cost for care.

All Charges