Heights University Hospital

All Charges

Charge

Type

Setting

Price

MEXILETINE CAP 150MG

Facility

$17.02

Service Code	NDC 93873901
Hospital Charge Code	60627582
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

MEXILETINE CAP 150MG

Facility

$17.02

Service Code	NDC 93873901
Hospital Charge Code	60627582
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.51
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare Advantage	$5.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.34
Rate for Payer: Cigna Commercial	$8.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.51

MEXILETINE CAP 200MG

Facility

$20.30

Service Code	NDC 93874001
Hospital Charge Code	60627583
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$10.15
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: Aetna Medicare Advantage	$6.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.18
Rate for Payer: Cigna Commercial	$10.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.64
Rate for Payer: Oxford Commercial	$10.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.04
Rate for Payer: UnitedHealthcare Commercial	$10.15

MEXILETINE CAP 200MG

Facility

$20.30

Service Code	NDC 93874001
Hospital Charge Code	60627583
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.04

MEXILETINE (QUANT)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3008232
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

MEXILETINE (QUANT)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3008232
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

MEXITIL/150MG/CAP

Facility

$6.00

Hospital Charge Code	60633418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MEXITIL/150MG/CAP

Facility

$6.00

Hospital Charge Code	60633418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

MEXITIL/150MG/CAP

Facility

$5.00

Hospital Charge Code	60633419
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

MEXITIL/150MG/CAP

Facility

$5.00

Hospital Charge Code	60633419
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MEXITIL/200MG/CAP

Facility

$5.00

Hospital Charge Code	60633421
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MEXITIL/200MG/CAP

Facility

$6.00

Hospital Charge Code	60633420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

MEXITIL/200MG/CAP

Facility

$5.00

Hospital Charge Code	60633421
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

MEXITIL/200MG/CAP

Facility

$6.00

Hospital Charge Code	60633420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MEXITIL/250MG/CAP

Facility

$6.00

Hospital Charge Code	60633422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MEXITIL/250MG/CAP

Facility

$6.00

Hospital Charge Code	60633422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

MEZLOCILLIN INJ 2GM

Facility

$55.70

Hospital Charge Code	6007603
Hospital Revenue Code	250
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$8.36
Rate for Payer: Qualcare PPO/HMO/WC	$8.36

MEZLOCILLIN INJ 2GM

Facility

$55.70

Hospital Charge Code	6007603
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$27.85
Rate for Payer: Aetna Commercial	$16.71
Rate for Payer: Aetna Medicare Advantage	$16.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.20
Rate for Payer: Cigna Commercial	$27.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.24
Rate for Payer: Oxford Commercial	$27.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.36
Rate for Payer: UnitedHealthcare Commercial	$27.85

MEZLOCILLIN INJ 3GM

Facility

$83.85

Hospital Charge Code	6007611
Hospital Revenue Code	250
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$12.58
Rate for Payer: Qualcare PPO/HMO/WC	$12.58

MEZLOCILLIN INJ 3GM

Facility

$83.85

Hospital Charge Code	6007611
Hospital Revenue Code	250
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$41.92
Rate for Payer: Aetna Commercial	$25.16
Rate for Payer: Aetna Medicare Advantage	$25.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.38
Rate for Payer: Cigna Commercial	$41.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.90
Rate for Payer: Oxford Commercial	$41.92
Rate for Payer: Qualcare PPO/HMO/WC	$12.58
Rate for Payer: UnitedHealthcare Commercial	$41.92

MEZLOCILLIN INJ 4GM

Facility

$104.35

Hospital Charge Code	6007629
Hospital Revenue Code	250
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$15.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.65

MEZLOCILLIN INJ 4GM

Facility

$104.35

Hospital Charge Code	6007629
Hospital Revenue Code	250
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$52.17
Rate for Payer: Aetna Commercial	$31.30
Rate for Payer: Aetna Medicare Advantage	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.61
Rate for Payer: Cigna Commercial	$52.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.57
Rate for Payer: Oxford Commercial	$52.17
Rate for Payer: Qualcare PPO/HMO/WC	$15.65
Rate for Payer: UnitedHealthcare Commercial	$52.17

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	6003719
Hospital Revenue Code	252
Min. Negotiated Rate	$123.06
Max. Negotiated Rate	$473.30
Rate for Payer: Aetna Commercial	$283.98
Rate for Payer: Aetna Medicare Advantage	$283.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.38
Rate for Payer: Cigna Commercial	$473.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.06
Rate for Payer: Oxford Commercial	$473.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.99
Rate for Payer: UnitedHealthcare Commercial	$473.30

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	60037193
Hospital Revenue Code	250
Min. Negotiated Rate	$123.06
Max. Negotiated Rate	$473.30
Rate for Payer: Aetna Commercial	$283.98
Rate for Payer: Aetna Medicare Advantage	$283.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.38
Rate for Payer: Cigna Commercial	$473.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.06
Rate for Payer: Oxford Commercial	$473.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.99
Rate for Payer: UnitedHealthcare Commercial	$473.30

MEZLOCILLIN OPH DROPS 100MG/ML

Facility

$946.60

Hospital Charge Code	6003719
Hospital Revenue Code	252
Min. Negotiated Rate	$141.99
Max. Negotiated Rate	$141.99
Rate for Payer: Qualcare PPO/HMO/WC	$141.99

Know your out-of-pocket cost for care.

All Charges