Heights University Hospital

All Charges

Charge

Type

Setting

Price

MESH VENTRIO OVAL SM 3.1x4.7

Facility

$3,253.50

Service Code	HCPCS C1781
Hospital Charge Code	270647195
Hospital Revenue Code	278
Min. Negotiated Rate	$488.02
Max. Negotiated Rate	$787.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.35
Rate for Payer: Qualcare PPO/HMO/WC	$488.02

MESH VENTRIO XLG OVAL

Facility

$8,650.00

Service Code	HCPCS C1781
Hospital Charge Code	270664952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.50
Max. Negotiated Rate	$2,093.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,093.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,297.50

MESH VENTRIO XLG OVAL

Facility

$8,650.00

Service Code	HCPCS C1781
Hospital Charge Code	270664952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.50
Max. Negotiated Rate	$4,325.00
Rate for Payer: Aetna Commercial	$2,595.00
Rate for Payer: Aetna Medicare Advantage	$2,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,205.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,205.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,205.75
Rate for Payer: Cigna Commercial	$4,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,093.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,297.50

MESH VIABAHN 9MM X 39MM 8 FR

Facility

$17,870.00

Service Code	HCPCS C1874
Hospital Charge Code	270692893
Hospital Revenue Code	278
Min. Negotiated Rate	$2,680.50
Max. Negotiated Rate	$8,935.00
Rate for Payer: Aetna Commercial	$5,361.00
Rate for Payer: Aetna Medicare Advantage	$5,361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,556.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,556.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,556.85
Rate for Payer: Cigna Commercial	$8,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,324.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.50

MESH VIABAHN 9MM X 39MM 8 FR

Facility

$17,870.00

Service Code	HCPCS C1874
Hospital Charge Code	270692893
Hospital Revenue Code	278
Min. Negotiated Rate	$2,680.50
Max. Negotiated Rate	$4,324.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,324.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.50

MESH VISILEX 3 X 6 0112900

Facility

$859.25

Hospital Charge Code	270601202
Hospital Revenue Code	278
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$429.62
Rate for Payer: Aetna Commercial	$257.77
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

MESH VISILEX 3 X 6 0112900

Facility

$859.25

Hospital Charge Code	270601202
Hospital Revenue Code	278
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$207.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

MESH Y UPSYLON

Facility

$5,550.00

Service Code	HCPCS C1763
Hospital Charge Code	270677083
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$1,665.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

MESH Y UPSYLON

Facility

$5,550.00

Service Code	HCPCS C1763
Hospital Charge Code	270677083
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

MESNA 100 MG/ML INJ (10 ML)

Facility

$1,469.04

Service Code	HCPCS J9209
Hospital Charge Code	60628835
Hospital Revenue Code	636
Min. Negotiated Rate	$220.36
Max. Negotiated Rate	$355.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.51
Rate for Payer: Qualcare PPO/HMO/WC	$220.36

MESNA 100 MG/ML INJ (10 ML)

Facility

$1,469.04

Service Code	HCPCS J9209
Hospital Charge Code	60628835
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$440.71
Rate for Payer: Aetna Commercial	$440.71
Rate for Payer: Aetna Medicare Advantage	$440.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$374.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$374.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$374.61
Rate for Payer: Cigna Commercial	$1.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.51
Rate for Payer: Qualcare PPO/HMO/WC	$220.36

MESNA 200MG

Facility

$1,124.00

Hospital Charge Code	60633379
Hospital Revenue Code	250
Min. Negotiated Rate	$146.12
Max. Negotiated Rate	$562.00
Rate for Payer: Aetna Commercial	$337.20
Rate for Payer: Aetna Medicare Advantage	$337.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.62
Rate for Payer: Cigna Commercial	$562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.12
Rate for Payer: Oxford Commercial	$562.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.60
Rate for Payer: UnitedHealthcare Commercial	$562.00

MESNA 200MG

Facility

$1,124.00

Hospital Charge Code	60633379
Hospital Revenue Code	250
Min. Negotiated Rate	$168.60
Max. Negotiated Rate	$168.60
Rate for Payer: Qualcare PPO/HMO/WC	$168.60

MESNA 200MG INJ

Facility

$122.90

Hospital Charge Code	6000368
Hospital Revenue Code	636
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$29.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.74
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

MESNA 200MG INJ

Facility

$122.90

Hospital Charge Code	6000368
Hospital Revenue Code	636
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$36.87
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.74
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

MESNA 400MG TAB

Facility

$63.18

Service Code	NDC 67108356509
Hospital Charge Code	60635803
Hospital Revenue Code	250
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$9.48
Rate for Payer: Qualcare PPO/HMO/WC	$9.48

MESNA 400MG TAB

Facility

$63.18

Service Code	NDC 67108356509
Hospital Charge Code	60635803
Hospital Revenue Code	250
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$31.59
Rate for Payer: Oxford Commercial	$31.59
Rate for Payer: Aetna Commercial	$18.95
Rate for Payer: Aetna Medicare Advantage	$18.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.11
Rate for Payer: Cigna Commercial	$31.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.21
Rate for Payer: Qualcare PPO/HMO/WC	$9.48
Rate for Payer: UnitedHealthcare Commercial	$31.59

MESNEX/100MG/1ML

Facility

$1,124.00

Hospital Charge Code	60633378
Hospital Revenue Code	636
Min. Negotiated Rate	$168.60
Max. Negotiated Rate	$562.00
Rate for Payer: Aetna Commercial	$337.20
Rate for Payer: Aetna Medicare Advantage	$337.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.62
Rate for Payer: Cigna Commercial	$562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.01
Rate for Payer: Qualcare PPO/HMO/WC	$168.60

MESNEX/100MG/1ML

Facility

$1,124.00

Hospital Charge Code	60633378
Hospital Revenue Code	636
Min. Negotiated Rate	$168.60
Max. Negotiated Rate	$272.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.01
Rate for Payer: Qualcare PPO/HMO/WC	$168.60

MESNEX INJ/1GM/10ML

Facility

$373.00

Hospital Charge Code	60634311
Hospital Revenue Code	636
Min. Negotiated Rate	$55.95
Max. Negotiated Rate	$90.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.27
Rate for Payer: Qualcare PPO/HMO/WC	$55.95

MESNEX INJ/1GM/10ML

Facility

$373.00

Hospital Charge Code	60634311
Hospital Revenue Code	636
Min. Negotiated Rate	$55.95
Max. Negotiated Rate	$186.50
Rate for Payer: Aetna Commercial	$111.90
Rate for Payer: Aetna Medicare Advantage	$111.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.11
Rate for Payer: Cigna Commercial	$186.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.27
Rate for Payer: Qualcare PPO/HMO/WC	$55.95

MESNEX INJ/400MG/4ML

Facility

$181.00

Hospital Charge Code	60634312
Hospital Revenue Code	636
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna Commercial	$54.30
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.16
Rate for Payer: Cigna Commercial	$90.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$27.15

MESNEX INJ/400MG/4ML

Facility

$181.00

Hospital Charge Code	60634312
Hospital Revenue Code	636
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$43.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$27.15

MESORIDAZIN BSYL LQ 25MG/ML4OZ

Facility

$320.00

Hospital Charge Code	6003529
Hospital Revenue Code	252
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

MESORIDAZIN BSYL LQ 25MG/ML4OZ

Facility

$320.00

Hospital Charge Code	6003529
Hospital Revenue Code	252
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna Commercial	$96.00
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Commercial	$160.00

Know your out-of-pocket cost for care.

All Charges