Heights University Hospital

All Charges

Charge

Type

Setting

Price

MIRTAZAPINE ODT 15MG TAB

Facility

$15.81

Service Code	NDC 65862002106
Hospital Charge Code	606361034
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$7.91
Rate for Payer: Aetna Commercial	$4.74
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.03
Rate for Payer: Cigna Commercial	$7.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.06
Rate for Payer: Oxford Commercial	$7.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.37
Rate for Payer: UnitedHealthcare Commercial	$7.91

MIRUS CYGNUS SCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704631
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

MIRUS CYGNUS SCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704631
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

MIS CALCANEAL S7 HOLE PLATE

Facility

$8,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270700420
Hospital Revenue Code	278
Min. Negotiated Rate	$1,308.00
Max. Negotiated Rate	$2,110.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,110.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,308.00

MIS CALCANEAL S7 HOLE PLATE

Facility

$8,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270700420
Hospital Revenue Code	278
Min. Negotiated Rate	$1,308.00
Max. Negotiated Rate	$4,360.00
Rate for Payer: Aetna Commercial	$2,616.00
Rate for Payer: Aetna Medicare Advantage	$2,616.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,223.60
Rate for Payer: Cigna Commercial	$4,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,110.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,308.00

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$50,589.00

Service Code	MSDRG 640
Min. Negotiated Rate	$14,574.85
Max. Negotiated Rate	$50,589.00
Rate for Payer: Aetna Commercial	$45,036.29
Rate for Payer: Aetna Medicare Advantage	$14,574.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,388.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,388.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,388.44
Rate for Payer: Cigna Commercial	$28,743.45
Rate for Payer: Cigna Medicare Advantage	$16,863.00
Rate for Payer: Clover Medicare Advantage	$16,019.85
Rate for Payer: EmblemHealth Commercial	$50,589.00
Rate for Payer: Humana Medicare Advantage	$17,368.89
Rate for Payer: Oxford Commercial	$17,963.82
Rate for Payer: UnitedHealthcare Commercial	$20,390.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,863.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17,874.78
Rate for Payer: Wellcare Medicare Advantage	$16,863.00

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$34,410.06

Service Code	MSDRG 641
Min. Negotiated Rate	$8,492.17
Max. Negotiated Rate	$34,410.06
Rate for Payer: Aetna Commercial	$26,240.81
Rate for Payer: Aetna Medicare Advantage	$8,492.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,502.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,502.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,470.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,502.26
Rate for Payer: Cigna Commercial	$16,747.64
Rate for Payer: Cigna Medicare Advantage	$11,470.02
Rate for Payer: Clover Medicare Advantage	$10,896.52
Rate for Payer: EmblemHealth Commercial	$34,410.06
Rate for Payer: Humana Medicare Advantage	$11,814.12
Rate for Payer: Oxford Commercial	$10,466.79
Rate for Payer: UnitedHealthcare Commercial	$11,880.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,470.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,158.22
Rate for Payer: Wellcare Medicare Advantage	$11,470.02

MISCELLANEOUS TRANS PROCEDURE

Facility

$100.00

Service Code	HCPCS 86999
Hospital Charge Code	3100189
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

MISCELLANEOUS TRANS PROCEDURE

Facility

$100.00

Service Code	HCPCS 86999
Hospital Charge Code	3100189
Hospital Revenue Code	300
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

MIS CURVED PRE-BENT ROD

Facility

$1,200.00

Hospital Charge Code	270703020
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

MIS CURVED PRE-BENT ROD

Facility

$1,200.00

Hospital Charge Code	270703020
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

MIS HANDPIECE W AO MODULE

Facility

$5,880.00

Hospital Charge Code	270704003
Hospital Revenue Code	279
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$882.00
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

MIS HANDPIECE W AO MODULE

Facility

$5,880.00

Hospital Charge Code	270704003
Hospital Revenue Code	279
Min. Negotiated Rate	$764.40
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$1,764.00
Rate for Payer: Aetna Medicare Advantage	$1,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,499.40
Rate for Payer: Cigna Commercial	$2,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.40
Rate for Payer: Oxford Commercial	$2,940.00
Rate for Payer: Qualcare PPO/HMO/WC	$882.00
Rate for Payer: UnitedHealthcare Commercial	$2,940.00

MIS HEADED SCREW 33MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681305
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS HEADED SCREW 33MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681305
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS HEADED SCREW 48MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681304
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS HEADED SCREW 48MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681304
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS IRRIGATION KIT

Facility

$630.00

Hospital Charge Code	270704188
Hospital Revenue Code	279
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.90
Rate for Payer: Oxford Commercial	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Commercial	$315.00

MIS IRRIGATION KIT

Facility

$630.00

Hospital Charge Code	270704188
Hospital Revenue Code	279
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

MIS MTP S-PLATE L

Facility

$7,750.00

Hospital Charge Code	270703226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

MIS MTP S-PLATE L

Facility

$7,750.00

Hospital Charge Code	270703226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

MISOPROSTOL 100 MCG TAB

Facility

$7.75

Hospital Charge Code	60628168
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

MISOPROSTOL 100 MCG TAB

Facility

$7.75

Hospital Charge Code	60628168
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.01
Rate for Payer: Oxford Commercial	$3.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.88

MISOPROSTOL 200 MCG TAB

Facility

$7.25

Hospital Charge Code	60628169
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

MISOPROSTOL 200 MCG TAB

Facility

$7.25

Hospital Charge Code	60628169
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

Know your out-of-pocket cost for care.

All Charges