Heights University Hospital

All Charges

Charge

Type

Setting

Price

MIS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705054
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

MIS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705054
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

MIS STERILE INSTR

Facility

$1,300.50

Hospital Charge Code	270702611
Hospital Revenue Code	270
Min. Negotiated Rate	$169.06
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna Medicare Advantage	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.63
Rate for Payer: Cigna Commercial	$650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.06
Rate for Payer: Oxford Commercial	$650.25
Rate for Payer: Qualcare PPO/HMO/WC	$195.07
Rate for Payer: UnitedHealthcare Commercial	$650.25

MIS STERILE INSTR

Facility

$1,300.50

Hospital Charge Code	270702611
Hospital Revenue Code	270
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$195.07
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS STERILE INSTRUMENT PACK W

Facility

$3,942.00

Hospital Charge Code	270703557
Hospital Revenue Code	272
Min. Negotiated Rate	$512.46
Max. Negotiated Rate	$1,971.00
Rate for Payer: Aetna Commercial	$1,182.60
Rate for Payer: Aetna Medicare Advantage	$1,182.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.21
Rate for Payer: Cigna Commercial	$1,971.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.46
Rate for Payer: Oxford Commercial	$1,971.00
Rate for Payer: Qualcare PPO/HMO/WC	$591.30
Rate for Payer: UnitedHealthcare Commercial	$1,971.00

MIS STERILE INSTRUMENT PACK W

Facility

$3,942.00

Hospital Charge Code	270703557
Hospital Revenue Code	272
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$591.30
Rate for Payer: Qualcare PPO/HMO/WC	$591.30

MIS STER INST PACK W/BLD MICA

Facility

$1,300.50

Service Code	HCPCS C1713
Hospital Charge Code	270702621
Hospital Revenue Code	278
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$314.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS STER INST PACK W/BLD MICA

Facility

$1,300.50

Service Code	HCPCS C1713
Hospital Charge Code	270702621
Hospital Revenue Code	278
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna Medicare Advantage	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.63
Rate for Payer: Cigna Commercial	$650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS TICP ROD 40MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705119
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

MIS TICP ROD 40MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705119
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

MIST THERAPY/DAY

Facility

$117.83

Service Code	HCPCS 97610
Hospital Charge Code	9808216
Hospital Revenue Code	940
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

MIST THERAPY/DAY

Facility

$117.83

Service Code	HCPCS 97610
Hospital Charge Code	9808216
Hospital Revenue Code	940
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$35.35
Rate for Payer: Aetna Medicare Advantage	$35.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.05
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.32
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.67
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

MITHRACIN/2500MCG

Facility

$414.00

Hospital Charge Code	60633441
Hospital Revenue Code	250
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.82
Rate for Payer: Oxford Commercial	$207.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$207.00

MITHRACIN/2500MCG

Facility

$414.00

Hospital Charge Code	60633441
Hospital Revenue Code	250
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

MITHRAMYCIN INJ 2.5MG

Facility

$552.35

Hospital Charge Code	6015077
Hospital Revenue Code	636
Min. Negotiated Rate	$82.85
Max. Negotiated Rate	$276.18
Rate for Payer: Aetna Commercial	$165.71
Rate for Payer: Aetna Medicare Advantage	$165.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.85
Rate for Payer: Cigna Commercial	$276.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.67
Rate for Payer: Qualcare PPO/HMO/WC	$82.85

MITHRAMYCIN INJ 2.5MG

Facility

$552.35

Hospital Charge Code	6015077
Hospital Revenue Code	636
Min. Negotiated Rate	$82.85
Max. Negotiated Rate	$133.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.67
Rate for Payer: Qualcare PPO/HMO/WC	$82.85

MITOCHONDRIAL AB W/RFX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900205
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MITOCHONDRIAL AB W/RFX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900205
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

MITOCHONDRIAL ANTIBODIES

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38476054
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

MITOCHONDRIAL ANTIBODIES

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38476054
Hospital Revenue Code	302
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

MITOCHONDRIAL ANTIBODY TI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39900207
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

MITOCHONDRIAL ANTIBODY TI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39900207
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

MITOCHRONDRIAL

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38479075
Hospital Revenue Code	302
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

MITOCHRONDRIAL

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38479075
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

MITOMYCIN 0.02% SYRINGE

Facility

$224.00

Hospital Charge Code	60635775
Hospital Revenue Code	636
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$54.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.21
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

Know your out-of-pocket cost for care.

All Charges