Heights University Hospital

All Charges

Charge

Type

Setting

Price

MANNITOL 5%

Facility

$49.00

Hospital Charge Code	60634497
Hospital Revenue Code	636
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

MANNITOL 5%

Facility

$49.00

Hospital Charge Code	60634497
Hospital Revenue Code	636
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$11.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

MANNITOL 500 ML SOL

Facility

$129.24

Service Code	NDC 264757810
Hospital Charge Code	60627971
Hospital Revenue Code	250
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.39

MANNITOL 500 ML SOL

Facility

$129.24

Service Code	NDC 264757810
Hospital Charge Code	60627971
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$64.62
Rate for Payer: Aetna Commercial	$38.77
Rate for Payer: Aetna Medicare Advantage	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.96
Rate for Payer: Cigna Commercial	$64.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$64.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.39
Rate for Payer: UnitedHealthcare Commercial	$64.62

MANNITOL 50 ML SOL

Facility

$10.10

Hospital Charge Code	6010144R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

MANNITOL 50 ML SOL

Facility

$10.10

Hospital Charge Code	6010144R
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$5.05
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$3.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.58
Rate for Payer: Cigna Commercial	$5.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$5.05

MANNITOL INJ 20% 500ML

Facility

$133.80

Hospital Charge Code	6003396
Hospital Revenue Code	250
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.07

MANNITOL INJ 20% 500ML

Facility

$133.80

Hospital Charge Code	6003396
Hospital Revenue Code	250
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$66.90
Rate for Payer: Aetna Commercial	$40.14
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.12
Rate for Payer: Cigna Commercial	$66.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.39
Rate for Payer: Oxford Commercial	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$20.07
Rate for Payer: UnitedHealthcare Commercial	$66.90

Mannitol/Sorbitol 3000ml

Facility

$105.32

Service Code	NDC 990798108
Hospital Charge Code	606361019
Hospital Revenue Code	250
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.80

Mannitol/Sorbitol 3000ml

Facility

$105.32

Service Code	NDC 990798108
Hospital Charge Code	606361019
Hospital Revenue Code	250
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$52.66
Rate for Payer: Aetna Commercial	$31.60
Rate for Payer: Aetna Medicare Advantage	$31.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.86
Rate for Payer: Cigna Commercial	$52.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.69
Rate for Payer: Oxford Commercial	$52.66
Rate for Payer: Qualcare PPO/HMO/WC	$15.80
Rate for Payer: UnitedHealthcare Commercial	$52.66

MANOMETER FOR CUFF

Facility

$167.00

Hospital Charge Code	270665164
Hospital Revenue Code	270
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.71
Rate for Payer: Oxford Commercial	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$83.50

MANOMETER FOR CUFF

Facility

$167.00

Hospital Charge Code	270665164
Hospital Revenue Code	270
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

MAN ROADRUNNER EXTRA SUPPORT

Facility

$612.50

Hospital Charge Code	270660263
Hospital Revenue Code	272
Min. Negotiated Rate	$79.62
Max. Negotiated Rate	$306.25
Rate for Payer: Aetna Commercial	$183.75
Rate for Payer: Aetna Medicare Advantage	$183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.19
Rate for Payer: Cigna Commercial	$306.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.62
Rate for Payer: Oxford Commercial	$306.25
Rate for Payer: Qualcare PPO/HMO/WC	$91.88
Rate for Payer: UnitedHealthcare Commercial	$306.25

MAN ROADRUNNER EXTRA SUPPORT

Facility

$612.50

Hospital Charge Code	270660263
Hospital Revenue Code	272
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$91.88
Rate for Payer: Qualcare PPO/HMO/WC	$91.88

MANUAL RETIC COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38479051
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

MANUAL RETIC COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38479051
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.96
Rate for Payer: Aetna Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.79
Rate for Payer: Cigna Commercial	$4.31
Rate for Payer: Cigna Medicare Advantage	$2.15
Rate for Payer: Clover Medicare Advantage	$4.09
Rate for Payer: EmblemHealth Commercial	$12.93
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.57
Rate for Payer: Wellcare Medicare Advantage	$4.31

MANUAL THERAPY EA 15 MIN CQ

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	409197140Q
Hospital Revenue Code	420
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

MANUAL THERAPY EA 15 MIN CQ

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	409197140Q
Hospital Revenue Code	420
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$42.49
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.41
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$686.00

MANUAL THRPY EACH 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008105
Hospital Revenue Code	420
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

MANUAL THRPY EACH 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008105
Hospital Revenue Code	420
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$42.60
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$686.00

MAPPING OF SENTINEL LYMPH NODE

Facility

$3,482.00

Service Code	HCPCS 38900
Hospital Charge Code	16000431
Hospital Revenue Code	360
Min. Negotiated Rate	$522.30
Max. Negotiated Rate	$522.30
Rate for Payer: Qualcare PPO/HMO/WC	$522.30

MAPPING OF SENTINEL LYMPH NODE

Facility

$3,482.00

Service Code	HCPCS 38900
Hospital Charge Code	16000431
Hospital Revenue Code	360
Min. Negotiated Rate	$132.86
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,044.60
Rate for Payer: Aetna Medicare Advantage	$1,044.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$887.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$887.91
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	$887.91
Rate for Payer: Cigna Commercial	$132.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.66
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$522.30
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

MAPROTILINE #S06***

Facility

$116.00

Hospital Charge Code	3010782
Hospital Revenue Code	301
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

MAPROTILINE #S06***

Facility

$116.00

Hospital Charge Code	3010782
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.58
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

MAPROTILINE TAB 25MG

Facility

$4.50

Hospital Charge Code	60628641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

Know your out-of-pocket cost for care.

All Charges