Heights University Hospital

All Charges

Charge

Type

Setting

Price

MELLARIL SUSPENSION/30CC

Facility

$17.00

Hospital Charge Code	60634803
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.50

MELPHADAN HYDROCHL/50ML

Facility

$1,577.00

Hospital Charge Code	60634985
Hospital Revenue Code	636
Min. Negotiated Rate	$236.55
Max. Negotiated Rate	$381.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.63
Rate for Payer: Qualcare PPO/HMO/WC	$236.55

MELPHADAN HYDROCHL/50ML

Facility

$1,577.00

Hospital Charge Code	60634985
Hospital Revenue Code	636
Min. Negotiated Rate	$236.55
Max. Negotiated Rate	$788.50
Rate for Payer: Aetna Commercial	$473.10
Rate for Payer: Aetna Medicare Advantage	$473.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$402.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$402.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$402.13
Rate for Payer: Cigna Commercial	$788.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.63
Rate for Payer: Qualcare PPO/HMO/WC	$236.55

MELPHALAN 2/MG

Facility

$5.00

Hospital Charge Code	60632418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

MELPHALAN 2/MG

Facility

$5.00

Hospital Charge Code	60632418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MELPHALAN INJ 50MG

Facility

$1,749.15

Hospital Charge Code	60627395
Hospital Revenue Code	636
Min. Negotiated Rate	$262.37
Max. Negotiated Rate	$874.58
Rate for Payer: Aetna Commercial	$524.75
Rate for Payer: Aetna Medicare Advantage	$524.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.03
Rate for Payer: Cigna Commercial	$874.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.29
Rate for Payer: Qualcare PPO/HMO/WC	$262.37

MELPHALAN INJ 50MG

Facility

$1,749.15

Hospital Charge Code	60627395
Hospital Revenue Code	636
Min. Negotiated Rate	$262.37
Max. Negotiated Rate	$423.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.29
Rate for Payer: Qualcare PPO/HMO/WC	$262.37

MELPHALAN TAB 2MG

Facility

$17.95

Hospital Charge Code	6009799
Hospital Revenue Code	251
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

MELPHALAN TAB 2MG

Facility

$17.95

Hospital Charge Code	6009799
Hospital Revenue Code	251
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

MELPHALAN TAB 2MG

Facility

$81.81

Service Code	HCPCS J8600
Hospital Charge Code	60627394
Hospital Revenue Code	636
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$19.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

MELPHALAN TAB 2MG

Facility

$81.81

Service Code	HCPCS J8600
Hospital Charge Code	60627394
Hospital Revenue Code	636
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$40.91
Rate for Payer: Aetna Commercial	$24.54
Rate for Payer: Aetna Medicare Advantage	$24.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$40.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

MEMANTINE 10MG

Facility

$41.88

Service Code	NDC 456321063
Hospital Charge Code	60629833
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.28

MEMANTINE 10MG

Facility

$41.88

Service Code	NDC 456321063
Hospital Charge Code	60629833
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$20.94
Rate for Payer: Aetna Commercial	$12.56
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.68
Rate for Payer: Cigna Commercial	$20.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.44
Rate for Payer: Oxford Commercial	$20.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.28
Rate for Payer: UnitedHealthcare Commercial	$20.94

MEMANTINE 5MG TAB UD

Facility

$41.88

Service Code	NDC 456320563
Hospital Charge Code	60629854
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$20.94
Rate for Payer: Aetna Commercial	$12.56
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.68
Rate for Payer: Cigna Commercial	$20.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.44
Rate for Payer: Oxford Commercial	$20.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.28
Rate for Payer: UnitedHealthcare Commercial	$20.94

MEMANTINE 5MG TAB UD

Facility

$41.88

Service Code	NDC 456320563
Hospital Charge Code	60629854
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.28

MEMBRANE AMNIOTIC 1.4X2CM

Facility

$2,875.00

Hospital Charge Code	270647386
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

MEMBRANE AMNIOTIC 1.4X2CM

Facility

$2,875.00

Hospital Charge Code	270647386
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$862.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

MEMBRANE PALIN GEN FLOW 1ML

Facility

$13,875.00

Hospital Charge Code	270676393
Hospital Revenue Code	272
Min. Negotiated Rate	$2,081.25
Max. Negotiated Rate	$2,081.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25

MEMBRANE PALIN GEN FLOW 1ML

Facility

$13,875.00

Hospital Charge Code	270676393
Hospital Revenue Code	272
Min. Negotiated Rate	$1,803.75
Max. Negotiated Rate	$6,937.50
Rate for Payer: Aetna Commercial	$4,162.50
Rate for Payer: Aetna Medicare Advantage	$4,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,538.12
Rate for Payer: Cigna Commercial	$6,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,803.75
Rate for Payer: Oxford Commercial	$6,937.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25
Rate for Payer: UnitedHealthcare Commercial	$6,937.50

MEMBRANE PALINGEN FLOW .25ML

Facility

$4,750.00

Service Code	HCPCS Q4139
Hospital Charge Code	270678044
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

MEMBRANE PALINGEN FLOW .25ML

Facility

$4,750.00

Service Code	HCPCS Q4139
Hospital Charge Code	270678044
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

MEMBRANE PALIN GEN FLOW .5ML

Facility

$9,500.00

Hospital Charge Code	270677473
Hospital Revenue Code	636
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

MEMBRANE PALIN GEN FLOW .5ML

Facility

$9,500.00

Hospital Charge Code	270677473
Hospital Revenue Code	636
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

MEMBRANE WRAP 4X8CM MW0408

Facility

$31,680.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694505
Hospital Revenue Code	278
Min. Negotiated Rate	$4,752.00
Max. Negotiated Rate	$7,666.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,666.56
Rate for Payer: Qualcare PPO/HMO/WC	$4,752.00

MEMBRANE WRAP 4X8CM MW0408

Facility

$31,680.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694505
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$9,504.00
Rate for Payer: Aetna Commercial	$9,504.00
Rate for Payer: Aetna Medicare Advantage	$9,504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,078.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,078.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,078.40
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,666.56
Rate for Payer: Qualcare PPO/HMO/WC	$4,752.00

Know your out-of-pocket cost for care.

All Charges