Heights University Hospital

All Charges

Charge

Type

Setting

Price

MMR/VZV PROFILE,EIA I

Facility

$390.00

Service Code	HCPCS 86735
Hospital Charge Code	39990121A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA I

Facility

$390.00

Service Code	HCPCS 86735
Hospital Charge Code	39990121A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.28
Rate for Payer: Aetna Medicare Advantage	$13.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.82
Rate for Payer: Cigna Commercial	$13.05
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$12.40
Rate for Payer: EmblemHealth Commercial	$39.15
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.83
Rate for Payer: Wellcare Medicare Advantage	$13.05

MMR/VZV PROFILE,EIA II

Facility

$390.00

Service Code	HCPCS 86762
Hospital Charge Code	39990121B
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

MMR/VZV PROFILE,EIA II

Facility

$390.00

Service Code	HCPCS 86762
Hospital Charge Code	39990121B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA III

Facility

$390.00

Service Code	HCPCS 86765
Hospital Charge Code	39990121C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA III

Facility

$390.00

Service Code	HCPCS 86765
Hospital Charge Code	39990121C
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

MMR/VZV PROFILE,EIA IV

Facility

$390.00

Service Code	HCPCS 86787
Hospital Charge Code	39990121D
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

MMR/VZV PROFILE,EIA IV

Facility

$390.00

Service Code	HCPCS 86787
Hospital Charge Code	39990121D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MNIPAQUE 240MG 50ML

Facility

$234.75

Service Code	HCPCS Q9966
Hospital Charge Code	64070005
Hospital Revenue Code	636
Min. Negotiated Rate	$35.21
Max. Negotiated Rate	$56.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.21

MNIPAQUE 240MG 50ML

Facility

$234.75

Service Code	HCPCS Q9966
Hospital Charge Code	64070005
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$70.42
Rate for Payer: Aetna Commercial	$70.42
Rate for Payer: Aetna Medicare Advantage	$70.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.86
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.21

MNL PREP&INSJ DP RX DLVR DEV

Facility

$201.37

Service Code	HCPCS 20700
Hospital Charge Code	1600000879
Hospital Revenue Code	360
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$1,864.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.21
Rate for Payer: Aetna Commercial	$60.41
Rate for Payer: Aetna Medicare Advantage	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.35
Rate for Payer: Cigna Commercial	$76.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.18
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

MNL PREP&INSJ DP RX DLVR DEV

Facility

$201.37

Service Code	HCPCS 20700
Hospital Charge Code	1600000879
Hospital Revenue Code	360
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$30.21
Rate for Payer: Qualcare PPO/HMO/WC	$30.21

MNL PREP&INSJ I-ARTIC RX DEV

Facility

$5,605.99

Service Code	HCPCS 20704
Hospital Charge Code	160000881
Hospital Revenue Code	360
Min. Negotiated Rate	$139.37
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,681.80
Rate for Payer: Aetna Medicare Advantage	$1,681.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,429.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,429.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,429.53
Rate for Payer: Cigna Commercial	$139.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.78
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

MNL PREP&INSJ I-ARTIC RX DEV

Facility

$5,605.99

Service Code	HCPCS 20704
Hospital Charge Code	160000881
Hospital Revenue Code	360
Min. Negotiated Rate	$840.90
Max. Negotiated Rate	$840.90
Rate for Payer: Qualcare PPO/HMO/WC	$840.90

MNL PREP&INSJ IMED RX DEV

Facility

$9,686.93

Service Code	HCPCS 20702
Hospital Charge Code	1600000880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,453.04
Max. Negotiated Rate	$1,453.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.04

MNL PREP&INSJ IMED RX DEV

Facility

$9,686.93

Service Code	HCPCS 20702
Hospital Charge Code	1600000880
Hospital Revenue Code	360
Min. Negotiated Rate	$133.17
Max. Negotiated Rate	$2,906.08
Rate for Payer: Aetna Commercial	$2,906.08
Rate for Payer: Aetna Medicare Advantage	$2,906.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,470.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,470.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,470.17
Rate for Payer: Cigna Commercial	$133.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,259.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.04
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

MNTREAS2NDREF IND EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS G0270
Hospital Charge Code	3016G0270
Hospital Revenue Code	942
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$24.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

MNTREAS2NDREF IND EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS G0270
Hospital Charge Code	3016G0270
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

MNTREASS2NDREF GROUP 30MIN

Facility

$2,700.00

Service Code	HCPCS G0271
Hospital Charge Code	3016G0271
Hospital Revenue Code	942
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$13.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

MNTREASS2NDREF GROUP 30MIN

Facility

$2,700.00

Service Code	HCPCS G0271
Hospital Charge Code	3016G0271
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

MNT SUBSEQ EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97803
Hospital Charge Code	395097803
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

MNT SUBSEQ EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97803
Hospital Charge Code	395097803
Hospital Revenue Code	942
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$24.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

MOBAN 10MG TAB

Facility

$3.00

Hospital Charge Code	60635118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

MOBAN 10MG TAB

Facility

$3.00

Hospital Charge Code	60635118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	9109130
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges