Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MAPROTILINE/VAPROTILINE (HPLC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3000783
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

MAPROTILINE/VAPROTILINE (HPLC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3000783
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

MAQUET QUADROX OXYGENATOR

Facility

$7,962.45

Hospital Charge Code	2703110A
Hospital Revenue Code	272
Min. Negotiated Rate	$1,035.12
Max. Negotiated Rate	$3,981.22
Rate for Payer: Aetna Commercial	$2,388.74
Rate for Payer: Aetna Medicare Advantage	$2,388.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,030.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,030.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,030.42
Rate for Payer: Cigna Commercial	$3,981.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.12
Rate for Payer: Oxford Commercial	$3,981.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.37
Rate for Payer: UnitedHealthcare Commercial	$3,981.22

MAQUET QUADROX OXYGENATOR

Facility

$7,962.45

Hospital Charge Code	2703110A
Hospital Revenue Code	272
Min. Negotiated Rate	$1,194.37
Max. Negotiated Rate	$1,194.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.37

MARCAINE 0.25% 10ML

Facility

$12.93

Service Code	NDC 409115901
Hospital Charge Code	606350928
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$3.88
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.68
Rate for Payer: Oxford Commercial	$6.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$6.46

MARCAINE 0.25% 10ML

Facility

$12.93

Service Code	NDC 409115901
Hospital Charge Code	606350928
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

MARCAINE 0.25% W/EPI/50ML

Facility

$48.00

Hospital Charge Code	60633354
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

MARCAINE 0.25% W/EPI/50ML

Facility

$48.00

Hospital Charge Code	60633354
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

MARCAINE 0.5% 10ML VIAL

Facility

$25.19

Service Code	NDC 409156010
Hospital Charge Code	606350953
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

MARCAINE 0.5% 10ML VIAL

Facility

$25.19

Service Code	NDC 409156010
Hospital Charge Code	606350953
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$7.56
Rate for Payer: Aetna Medicare Advantage	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$12.60

MARCAINE 0.5% 50ML

Facility

$33.77

Service Code	NDC 409161050
Hospital Charge Code	6063943295
Hospital Revenue Code	250
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$16.89
Rate for Payer: Aetna Commercial	$10.13
Rate for Payer: Aetna Medicare Advantage	$10.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.61
Rate for Payer: Cigna Commercial	$16.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.39
Rate for Payer: Oxford Commercial	$16.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.07
Rate for Payer: UnitedHealthcare Commercial	$16.89

MARCAINE 0.5% 50ML

Facility

$33.77

Service Code	NDC 409161050
Hospital Charge Code	6063943295
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.07

MARCAINE.25%W EPI1:200000 50ML

Facility

$53.27

Service Code	NDC 409381201
Hospital Charge Code	606390545
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$26.64
Rate for Payer: Aetna Commercial	$15.98
Rate for Payer: Aetna Medicare Advantage	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.58
Rate for Payer: Cigna Commercial	$26.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.93
Rate for Payer: Oxford Commercial	$26.64
Rate for Payer: Qualcare PPO/HMO/WC	$7.99
Rate for Payer: UnitedHealthcare Commercial	$26.64

MARCAINE.25%W EPI1:200000 50ML

Facility

$53.27

Service Code	NDC 409381201
Hospital Charge Code	606390545
Hospital Revenue Code	250
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$7.99

MARCAINE/DEXTROSE

Facility

$8.64

Hospital Charge Code	60635813
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

MARCAINE/DEXTROSE

Facility

$8.64

Hospital Charge Code	60635813
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$4.32

MARCAINE W EPI 0.5% 1 200000

Facility

$25.46

Service Code	NDC 409174910
Hospital Charge Code	606380002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$7.64
Rate for Payer: Aetna Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.49
Rate for Payer: Cigna Commercial	$12.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.31
Rate for Payer: Oxford Commercial	$12.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.82
Rate for Payer: UnitedHealthcare Commercial	$12.73

MARCAINE W EPI 0.5% 1 200000

Facility

$25.46

Service Code	NDC 409174910
Hospital Charge Code	606380002
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.82

MARDIS URETERAL STENT 6FRX24CM

Facility

$955.00

Hospital Charge Code	270332071
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

MARDIS URETERAL STENT 6FRX24CM

Facility

$955.00

Hospital Charge Code	270332071
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$286.50
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

MARIJUANA

Facility

$324.00

Service Code	HCPCS 80300
Hospital Charge Code	38472476
Hospital Revenue Code	301
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

MARIJUANA

Facility

$324.00

Service Code	HCPCS 80300
Hospital Charge Code	38472476
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

MARIJUANA CONFIRMATION

Facility

$124.10

Service Code	HCPCS 82542
Hospital Charge Code	39900068
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.61
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

MARIJUANA CONFIRMATION

Facility

$124.10

Service Code	HCPCS 82542
Hospital Charge Code	39900068
Hospital Revenue Code	301
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

Know your out-of-pocket cost for care.

All Charges