Heights University Hospital

All Charges

Charge

Type

Setting

Price

M3 ALIF SCREW 5.5X20MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704773
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

M/6-S/L 500*****

Facility

$20.00

Hospital Charge Code	7000342
Hospital Revenue Code	258
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

M/6-S/L 500*****

Facility

$20.00

Hospital Charge Code	7000342
Hospital Revenue Code	258
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$10.00

MAA30/BENL30/XYL2%

Facility

$43.00

Hospital Charge Code	60634875
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

MAA30/BENL30/XYL2%

Facility

$43.00

Hospital Charge Code	60634875
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

MAALOX/30ML

Facility

$37.99

Service Code	NDC 121176030
Hospital Charge Code	60633342
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

MAALOX/30ML

Facility

$37.99

Service Code	NDC 121176030
Hospital Charge Code	60633342
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

MAALOX PLUS/30ML

Facility

$1.00

Hospital Charge Code	60633344
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

MAALOX PLUS/30ML

Facility

$1.00

Hospital Charge Code	60633344
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

MAALOX PLUS/TAB

Facility

$3.00

Hospital Charge Code	60633346
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MAALOX PLUS/TAB

Facility

$3.00

Hospital Charge Code	60633345
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

MAALOX PLUS/TAB

Facility

$3.00

Hospital Charge Code	60633345
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MAALOX PLUS/TAB

Facility

$3.00

Hospital Charge Code	60633346
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

MAALOX/TAB

Facility

$3.00

Hospital Charge Code	60633343
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

MAALOX/TAB

Facility

$3.00

Hospital Charge Code	60633343
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MAALOX TC/30ML

Facility

$7.00

Hospital Charge Code	60634609
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MAALOX TC/30ML

Facility

$7.00

Hospital Charge Code	60634609
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

MAA VIAL COLD KIT

Facility

$62.75

Hospital Charge Code	270658219
Hospital Revenue Code	270
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$31.38
Rate for Payer: Aetna Commercial	$18.82
Rate for Payer: Aetna Medicare Advantage	$18.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.00
Rate for Payer: Cigna Commercial	$31.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.16
Rate for Payer: Oxford Commercial	$31.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.41
Rate for Payer: UnitedHealthcare Commercial	$31.38

MAA VIAL COLD KIT

Facility

$62.75

Hospital Charge Code	270658219
Hospital Revenue Code	270
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$9.41
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

MA BREAST NDL LOC PLC BILAT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700016
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MA BREAST NDL LOC PLC BILAT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700016
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

MA BREAST NDL LOC PLC LEFT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700003
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

MA BREAST NDL LOC PLC LEFT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700003
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MA BREAST NDL LOC PLC RIGHT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700004
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MA BREAST NDL LOC PLC RIGHT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700004
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

Know your out-of-pocket cost for care.

All Charges