Heights University Hospital

All Charges

Charge

Type

Setting

Price

MIO MEDICAL DEVICE ORGANIZER

Facility

$86.67

Hospital Charge Code	270658155
Hospital Revenue Code	270
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.00

MIO MEDICAL DEVICE ORGANIZER

Facility

$86.67

Hospital Charge Code	270658155
Hospital Revenue Code	270
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$43.34
Rate for Payer: Aetna Commercial	$26.00
Rate for Payer: Aetna Medicare Advantage	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.10
Rate for Payer: Cigna Commercial	$43.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.27
Rate for Payer: Oxford Commercial	$43.34
Rate for Payer: Qualcare PPO/HMO/WC	$13.00
Rate for Payer: UnitedHealthcare Commercial	$43.34

MIOSTAT 0.01% SDV

Facility

$236.91

Service Code	NDC 65002315
Hospital Charge Code	606390042
Hospital Revenue Code	250
Min. Negotiated Rate	$35.54
Max. Negotiated Rate	$35.54
Rate for Payer: Qualcare PPO/HMO/WC	$35.54

MIOSTAT 0.01% SDV

Facility

$236.91

Service Code	NDC 65002315
Hospital Charge Code	606390042
Hospital Revenue Code	250
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$118.45
Rate for Payer: Aetna Commercial	$71.07
Rate for Payer: Aetna Medicare Advantage	$71.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.41
Rate for Payer: Cigna Commercial	$118.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.80
Rate for Payer: Oxford Commercial	$118.45
Rate for Payer: Qualcare PPO/HMO/WC	$35.54
Rate for Payer: UnitedHealthcare Commercial	$118.45

MIRACLE MOUTHWASH

Facility

$294.80

Service Code	NDC 10223030101
Hospital Charge Code	60635521
Hospital Revenue Code	250
Min. Negotiated Rate	$38.32
Max. Negotiated Rate	$147.40
Rate for Payer: Aetna Commercial	$88.44
Rate for Payer: Aetna Medicare Advantage	$88.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.17
Rate for Payer: Cigna Commercial	$147.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.32
Rate for Payer: Oxford Commercial	$147.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.22
Rate for Payer: UnitedHealthcare Commercial	$147.40

MIRACLE MOUTHWASH

Facility

$294.80

Service Code	NDC 10223030101
Hospital Charge Code	60635521
Hospital Revenue Code	250
Min. Negotiated Rate	$44.22
Max. Negotiated Rate	$44.22
Rate for Payer: Qualcare PPO/HMO/WC	$44.22

MIRALAX PWD 17GM

Facility

$9.00

Hospital Charge Code	60635544
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

MIRALAX PWD 17GM

Facility

$9.00

Hospital Charge Code	60635544
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

MIRAPEX 1.5MG TAB

Facility

$7.00

Hospital Charge Code	60635192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MIRAPEX 1.5MG TAB

Facility

$7.00

Hospital Charge Code	60635192
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

MIRAPEX 1MG TAB

Facility

$19.77

Service Code	NDC 13668009490
Hospital Charge Code	60635193
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

MIRAPEX 1MG TAB

Facility

$19.77

Service Code	NDC 13668009490
Hospital Charge Code	60635193
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$9.88
Rate for Payer: Aetna Commercial	$5.93
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.57
Rate for Payer: Oxford Commercial	$9.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$9.88

MIRCO CLIPS SUERFINE TITANIUM

Facility

$54.17

Hospital Charge Code	270663933
Hospital Revenue Code	270
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$8.13
Rate for Payer: Qualcare PPO/HMO/WC	$8.13

MIRCO CLIPS SUERFINE TITANIUM

Facility

$54.17

Hospital Charge Code	270663933
Hospital Revenue Code	270
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$27.09
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: Aetna Medicare Advantage	$16.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.81
Rate for Payer: Cigna Commercial	$27.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.04
Rate for Payer: Oxford Commercial	$27.09
Rate for Payer: Qualcare PPO/HMO/WC	$8.13
Rate for Payer: UnitedHealthcare Commercial	$27.09

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	270677501
Hospital Revenue Code	636
Min. Negotiated Rate	$220.72
Max. Negotiated Rate	$356.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: Qualcare PPO/HMO/WC	$220.72

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	270677501
Hospital Revenue Code	636
Min. Negotiated Rate	$220.72
Max. Negotiated Rate	$735.75
Rate for Payer: Aetna Commercial	$441.45
Rate for Payer: Aetna Medicare Advantage	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.23
Rate for Payer: Cigna Commercial	$735.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: Qualcare PPO/HMO/WC	$220.72

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	87502785
Hospital Revenue Code	278
Min. Negotiated Rate	$220.72
Max. Negotiated Rate	$735.75
Rate for Payer: Aetna Commercial	$441.45
Rate for Payer: Aetna Medicare Advantage	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.23
Rate for Payer: Cigna Commercial	$735.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: Qualcare PPO/HMO/WC	$220.72

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	87502785
Hospital Revenue Code	278
Min. Negotiated Rate	$220.72
Max. Negotiated Rate	$356.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: Qualcare PPO/HMO/WC	$220.72

MIRTAZAPINE 15 MG TAB

Facility

$18.22

Service Code	NDC 51079008620
Hospital Charge Code	60628850
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$9.11
Rate for Payer: Aetna Commercial	$5.47
Rate for Payer: Aetna Medicare Advantage	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.65
Rate for Payer: Cigna Commercial	$9.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.37
Rate for Payer: Oxford Commercial	$9.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.73
Rate for Payer: UnitedHealthcare Commercial	$9.11

MIRTAZAPINE 15 MG TAB

Facility

$18.22

Service Code	NDC 51079008620
Hospital Charge Code	60628850
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.73

MIRTAZAPINE 30 MG ODT

Facility

$17.96

Service Code	NDC 66993071130
Hospital Charge Code	6063943266
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.98
Rate for Payer: Aetna Commercial	$5.39
Rate for Payer: Aetna Medicare Advantage	$5.39
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	$8.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.98

MIRTAZAPINE 30 MG ODT

Facility

$17.96

Service Code	NDC 66993071130
Hospital Charge Code	6063943266
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

MIRTAZAPINE 30 MG TAB

Facility

$18.76

Service Code	NDC 51079008720
Hospital Charge Code	60628851
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.81

MIRTAZAPINE 30 MG TAB

Facility

$18.76

Service Code	NDC 51079008720
Hospital Charge Code	60628851
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$9.38
Rate for Payer: Aetna Commercial	$5.63
Rate for Payer: Aetna Medicare Advantage	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.78
Rate for Payer: Cigna Commercial	$9.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.44
Rate for Payer: Oxford Commercial	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$9.38

MIRTAZAPINE ODT 15MG TAB

Facility

$15.81

Service Code	NDC 65862002106
Hospital Charge Code	606361034
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

Know your out-of-pocket cost for care.

All Charges