Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MITOMYCIN 20 MG INJ

Facility

$4,742.39

Service Code	HCPCS J9280
Hospital Charge Code	60627402
Hospital Revenue Code	636
Min. Negotiated Rate	$711.36
Max. Negotiated Rate	$1,422.72
Rate for Payer: Aetna Commercial	$1,422.72
Rate for Payer: Aetna Medicare Advantage	$1,422.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,209.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,209.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,209.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.66
Rate for Payer: Qualcare PPO/HMO/WC	$711.36

MITOMYCIN 20 MG INJ

Facility

$4,742.39

Service Code	HCPCS J9280
Hospital Charge Code	60627402
Hospital Revenue Code	636
Min. Negotiated Rate	$711.36
Max. Negotiated Rate	$1,147.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.66
Rate for Payer: Qualcare PPO/HMO/WC	$711.36

MITOMYCIN 40 MG INJ

Facility

$9,484.79

Service Code	HCPCS J9280
Hospital Charge Code	6007686
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.72
Max. Negotiated Rate	$2,295.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,295.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.72

MITOMYCIN 40 MG INJ

Facility

$9,484.79

Service Code	HCPCS J9280
Hospital Charge Code	6007686
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.72
Max. Negotiated Rate	$2,845.44
Rate for Payer: Aetna Commercial	$2,845.44
Rate for Payer: Aetna Medicare Advantage	$2,845.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,418.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,418.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,418.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,295.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.72

MITOMYCIN 5 MG INJ

Facility

$1,825.48

Service Code	HCPCS J9280
Hospital Charge Code	6003792
Hospital Revenue Code	636
Min. Negotiated Rate	$273.82
Max. Negotiated Rate	$441.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.77
Rate for Payer: Qualcare PPO/HMO/WC	$273.82

MITOMYCIN 5 MG INJ

Facility

$1,825.48

Service Code	HCPCS J9280
Hospital Charge Code	6003792
Hospital Revenue Code	636
Min. Negotiated Rate	$273.82
Max. Negotiated Rate	$547.64
Rate for Payer: Aetna Commercial	$547.64
Rate for Payer: Aetna Medicare Advantage	$547.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.77
Rate for Payer: Qualcare PPO/HMO/WC	$273.82

MITOMYCIN INJ 20MG

Facility

$3,453.45

Hospital Charge Code	6003800
Hospital Revenue Code	636
Min. Negotiated Rate	$518.02
Max. Negotiated Rate	$1,726.72
Rate for Payer: Aetna Commercial	$1,036.04
Rate for Payer: Aetna Medicare Advantage	$1,036.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$880.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$880.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$880.63
Rate for Payer: Cigna Commercial	$1,726.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.73
Rate for Payer: Qualcare PPO/HMO/WC	$518.02

MITOMYCIN INJ 20MG

Facility

$3,453.45

Hospital Charge Code	6003800
Hospital Revenue Code	636
Min. Negotiated Rate	$518.02
Max. Negotiated Rate	$835.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.73
Rate for Payer: Qualcare PPO/HMO/WC	$518.02

MITO/SMTH W/RFLX

Facility

$435.00

Service Code	HCPCS 86256
Hospital Charge Code	3035088D
Hospital Revenue Code	300
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$65.25
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

MITO/SMTH W/RFLX

Facility

$435.00

Service Code	HCPCS 86256
Hospital Charge Code	3035088D
Hospital Revenue Code	300
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	$56.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
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

MITO/SMTH W/RFLX

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088C
Hospital Revenue Code	300
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

MITO/SMTH W/RFLX

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088B
Hospital Revenue Code	300
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

MITO/SMTH W/RFLX

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088C
Hospital Revenue Code	300
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	$10.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
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

MITO/SMTH W/RFLX

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088A
Hospital Revenue Code	300
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	$10.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
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

MITO/SMTH W/RFLX

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088B
Hospital Revenue Code	300
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	$10.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
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

MITO/SMTH W/RFLX

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088A
Hospital Revenue Code	300
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

MITOXANTRONE 2 MG/ML INJ

Facility

$1,740.46

Service Code	HCPCS J9293
Hospital Charge Code	60627403
Hospital Revenue Code	636
Min. Negotiated Rate	$261.07
Max. Negotiated Rate	$421.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.19
Rate for Payer: Qualcare PPO/HMO/WC	$261.07

MITOXANTRONE 2 MG/ML INJ

Facility

$1,740.46

Service Code	HCPCS J9293
Hospital Charge Code	60627403
Hospital Revenue Code	636
Min. Negotiated Rate	$261.07
Max. Negotiated Rate	$522.14
Rate for Payer: Aetna Commercial	$522.14
Rate for Payer: Aetna Medicare Advantage	$522.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.19
Rate for Payer: Qualcare PPO/HMO/WC	$261.07

MITOXANTRONE HYDROCHL 5MG

Facility

$3,174.00

Hospital Charge Code	60633555
Hospital Revenue Code	636
Min. Negotiated Rate	$476.10
Max. Negotiated Rate	$1,587.00
Rate for Payer: Aetna Commercial	$952.20
Rate for Payer: Aetna Medicare Advantage	$952.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$809.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$809.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$809.37
Rate for Payer: Cigna Commercial	$1,587.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.11
Rate for Payer: Qualcare PPO/HMO/WC	$476.10

MITOXANTRONE HYDROCHL 5MG

Facility

$3,174.00

Hospital Charge Code	60633555
Hospital Revenue Code	636
Min. Negotiated Rate	$476.10
Max. Negotiated Rate	$768.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.11
Rate for Payer: Qualcare PPO/HMO/WC	$476.10

MITOXANTRONE INJ 20MG

Facility

$3,282.60

Hospital Charge Code	6000343
Hospital Revenue Code	636
Min. Negotiated Rate	$492.39
Max. Negotiated Rate	$794.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.39
Rate for Payer: Qualcare PPO/HMO/WC	$492.39

MITOXANTRONE INJ 20MG

Facility

$3,282.60

Hospital Charge Code	6000343
Hospital Revenue Code	636
Min. Negotiated Rate	$492.39
Max. Negotiated Rate	$1,641.30
Rate for Payer: Aetna Commercial	$984.78
Rate for Payer: Aetna Medicare Advantage	$984.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$837.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$837.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$837.06
Rate for Payer: Cigna Commercial	$1,641.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.39
Rate for Payer: Qualcare PPO/HMO/WC	$492.39

MITOXANTRONE INJ 25MG

Facility

$3,417.00

Hospital Charge Code	6017131
Hospital Revenue Code	636
Min. Negotiated Rate	$512.55
Max. Negotiated Rate	$1,708.50
Rate for Payer: Aetna Commercial	$1,025.10
Rate for Payer: Aetna Medicare Advantage	$1,025.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.34
Rate for Payer: Cigna Commercial	$1,708.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.91
Rate for Payer: Qualcare PPO/HMO/WC	$512.55

MITOXANTRONE INJ 25MG

Facility

$3,417.00

Hospital Charge Code	6017131
Hospital Revenue Code	636
Min. Negotiated Rate	$512.55
Max. Negotiated Rate	$826.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.91
Rate for Payer: Qualcare PPO/HMO/WC	$512.55

Know your out-of-pocket cost for care.

All Charges