Heights University Hospital

All Charges

Charge

Type

Setting

Price

MANIPULATE KNEE JNT UNDR ANES

Facility

$32,127.31

Service Code	HCPCS 27570
Hospital Charge Code	16000215
Hospital Revenue Code	360
Min. Negotiated Rate	$4,819.10
Max. Negotiated Rate	$4,819.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,819.10

MANIPULATE WST W ANESTH LT

Facility

$19,424.35

Service Code	HCPCS 25259
Hospital Charge Code	16000394
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,827.31
Rate for Payer: Aetna Better Health Medicaid	$4,318.43
Rate for Payer: Aetna Commercial	$5,827.31
Rate for Payer: Aetna Medicare Advantage	$5,827.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,953.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,953.21
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	$4,953.21
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,525.17
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,913.65
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,404.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4,318.43

MANIPULATE WST W ANESTH LT

Facility

$19,424.35

Service Code	HCPCS 25259
Hospital Charge Code	16000394
Hospital Revenue Code	360
Min. Negotiated Rate	$2,913.65
Max. Negotiated Rate	$2,913.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,913.65

MANIPULATOR HUMI *******

Facility

$131.00

Hospital Charge Code	1601061
Hospital Revenue Code	272
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$65.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$65.50

MANIPULATOR HUMI *******

Facility

$131.00

Hospital Charge Code	1601061
Hospital Revenue Code	272
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

MANIPULATOR HUMI UTERINE 6003

Facility

$326.77

Hospital Charge Code	270600266
Hospital Revenue Code	272
Min. Negotiated Rate	$49.02
Max. Negotiated Rate	$49.02
Rate for Payer: Qualcare PPO/HMO/WC	$49.02

MANIPULATOR HUMI UTERINE 6003

Facility

$326.77

Hospital Charge Code	270600266
Hospital Revenue Code	272
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$163.38
Rate for Payer: Aetna Commercial	$98.03
Rate for Payer: Aetna Medicare Advantage	$98.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.33
Rate for Payer: Cigna Commercial	$163.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.48
Rate for Payer: Oxford Commercial	$163.38
Rate for Payer: Qualcare PPO/HMO/WC	$49.02
Rate for Payer: UnitedHealthcare Commercial	$163.38

MANIPULATOR UTERINE 4.5MM

Facility

$129.83

Hospital Charge Code	270649443
Hospital Revenue Code	272
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$64.92
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$38.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.11
Rate for Payer: Cigna Commercial	$64.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.88
Rate for Payer: Oxford Commercial	$64.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.47
Rate for Payer: UnitedHealthcare Commercial	$64.92

MANIPULATOR UTERINE 4.5MM

Facility

$129.83

Hospital Charge Code	270649443
Hospital Revenue Code	272
Min. Negotiated Rate	$19.47
Max. Negotiated Rate	$19.47
Rate for Payer: Qualcare PPO/HMO/WC	$19.47

MANNICAL REPAIR DEVICE

Facility

$4,785.00

Hospital Charge Code	270661102
Hospital Revenue Code	270
Min. Negotiated Rate	$622.05
Max. Negotiated Rate	$2,392.50
Rate for Payer: Aetna Commercial	$1,435.50
Rate for Payer: Aetna Medicare Advantage	$1,435.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,220.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,220.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,220.17
Rate for Payer: Cigna Commercial	$2,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.05
Rate for Payer: Oxford Commercial	$2,392.50
Rate for Payer: Qualcare PPO/HMO/WC	$717.75
Rate for Payer: UnitedHealthcare Commercial	$2,392.50

MANNICAL REPAIR DEVICE

Facility

$4,785.00

Hospital Charge Code	270661102
Hospital Revenue Code	270
Min. Negotiated Rate	$717.75
Max. Negotiated Rate	$717.75
Rate for Payer: Qualcare PPO/HMO/WC	$717.75

MANNITOL 10% 1000ML*****

Facility

$75.00

Hospital Charge Code	7000292
Hospital Revenue Code	258
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

MANNITOL 10% 1000ML*****

Facility

$75.00

Hospital Charge Code	7000292
Hospital Revenue Code	258
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

MANNITOL 12.5 GM/50 ML INJ

Facility

$13.53

Service Code	HCPCS J2151
Hospital Charge Code	6010144
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$4.06
Rate for Payer: Aetna Commercial	$4.06
Rate for Payer: Aetna Medicare Advantage	$4.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.45
Rate for Payer: Cigna Commercial	$0.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

MANNITOL 12.5 GM/50 ML INJ

Facility

$13.53

Service Code	HCPCS J2151
Hospital Charge Code	6010144
Hospital Revenue Code	636
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$3.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

MANNITOL 20% 100G/500 ML IVCI

Facility

$344.35

Hospital Charge Code	60628640
Hospital Revenue Code	250
Min. Negotiated Rate	$44.77
Max. Negotiated Rate	$172.18
Rate for Payer: Aetna Commercial	$103.31
Rate for Payer: Aetna Medicare Advantage	$103.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.81
Rate for Payer: Cigna Commercial	$172.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Oxford Commercial	$172.18
Rate for Payer: Qualcare PPO/HMO/WC	$51.65
Rate for Payer: UnitedHealthcare Commercial	$172.18

MANNITOL 20% 100G/500 ML IVCI

Facility

$344.35

Hospital Charge Code	60628640
Hospital Revenue Code	250
Min. Negotiated Rate	$51.65
Max. Negotiated Rate	$51.65
Rate for Payer: Qualcare PPO/HMO/WC	$51.65

MANNITOL 20% 500ML ******

Facility

$52.00

Hospital Charge Code	7000300
Hospital Revenue Code	258
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

MANNITOL 20% 500ML ******

Facility

$52.00

Hospital Charge Code	7000300
Hospital Revenue Code	258
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

MANNITOL 20% 500ML IN G

Facility

$80.00

Hospital Charge Code	270040091
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

MANNITOL 20% 500ML IN G

Facility

$80.00

Hospital Charge Code	270040091
Hospital Revenue Code	272
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

MANNITOL 20% INFUSION 500ML

Facility

$79.40

Hospital Charge Code	6012819
Hospital Revenue Code	250
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$39.70
Rate for Payer: Aetna Commercial	$23.82
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$39.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Oxford Commercial	$39.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.91
Rate for Payer: UnitedHealthcare Commercial	$39.70

MANNITOL 20% INFUSION 500ML

Facility

$79.40

Hospital Charge Code	6012819
Hospital Revenue Code	250
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$11.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

MANNITOL 25%/12.5GM/50ML

Facility

$15.00

Hospital Charge Code	60633353
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

MANNITOL 25%/12.5GM/50ML

Facility

$15.00

Hospital Charge Code	60633353
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

Know your out-of-pocket cost for care.

All Charges