Heights University Hospital

All Charges

Charge

Type

Setting

Price

MOLECULE NUCLEIC AMPLI

Facility

$121.00

Hospital Charge Code	3004168D
Hospital Revenue Code	301
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$36.30
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$114.00

MOLECULE NUCLEIC AMPLI

Facility

$121.00

Hospital Charge Code	3004168D
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

MOLEDULAR ISOLATION (3)

Facility

$568.00

Service Code	HCPCS 83890
Hospital Charge Code	38473133
Hospital Revenue Code	301
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$85.20
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

MOLEDULAR ISOLATION (3)

Facility

$568.00

Service Code	HCPCS 83890
Hospital Charge Code	38473133
Hospital Revenue Code	301
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$170.40
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

MOLESKIN

Facility

$195.25

Hospital Charge Code	270300185
Hospital Revenue Code	270
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$97.62
Rate for Payer: Aetna Commercial	$58.58
Rate for Payer: Aetna Medicare Advantage	$58.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.79
Rate for Payer: Cigna Commercial	$97.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.38
Rate for Payer: Oxford Commercial	$97.62
Rate for Payer: Qualcare PPO/HMO/WC	$29.29
Rate for Payer: UnitedHealthcare Commercial	$97.62

MOLESKIN

Facility

$195.25

Hospital Charge Code	270300185
Hospital Revenue Code	270
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$29.29
Rate for Payer: Qualcare PPO/HMO/WC	$29.29

MOLINDONE 25 MG TAB

Facility

$15.10

Hospital Charge Code	60628655
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$2.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

MOLINDONE 25 MG TAB

Facility

$15.10

Hospital Charge Code	60628655
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$7.55
Rate for Payer: Aetna Commercial	$4.53
Rate for Payer: Aetna Medicare Advantage	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.96
Rate for Payer: Oxford Commercial	$7.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.27
Rate for Payer: UnitedHealthcare Commercial	$7.55

MOLLELAST GAUZE 10X

Facility

$3.95

Hospital Charge Code	270636432
Hospital Revenue Code	272
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.98
Rate for Payer: Aetna Commercial	$1.19
Rate for Payer: Aetna Medicare Advantage	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.01
Rate for Payer: Cigna Commercial	$1.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.51
Rate for Payer: Oxford Commercial	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.59
Rate for Payer: UnitedHealthcare Commercial	$1.98

MOLLELAST GAUZE 10X

Facility

$3.95

Hospital Charge Code	270636432
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Qualcare PPO/HMO/WC	$0.59

MOLLELAST GAUZE 6X

Facility

$3.35

Hospital Charge Code	270636431
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna Commercial	$1.00
Rate for Payer: Aetna Medicare Advantage	$1.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.85
Rate for Payer: Cigna Commercial	$1.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.44
Rate for Payer: Oxford Commercial	$1.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.50
Rate for Payer: UnitedHealthcare Commercial	$1.68

MOLLELAST GAUZE 6X

Facility

$3.35

Hospital Charge Code	270636431
Hospital Revenue Code	272
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.50

MOM/15CC/UD

Facility

$3.00

Hospital Charge Code	60634629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MOM/15CC/UD

Facility

$3.00

Hospital Charge Code	60634629
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

MOM 15ML & CASCARA 2.5ML

Facility

$1.00

Hospital Charge Code	60635134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

MOM 15ML & CASCARA 2.5ML

Facility

$1.00

Hospital Charge Code	60635134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752
Hospital Revenue Code	272
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.00
Rate for Payer: Oxford Commercial	$4,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Commercial	$4,000.00

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752
Hospital Revenue Code	272
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.00
Rate for Payer: Oxford Commercial	$4,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Commercial	$4,000.00

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

MOMETASONE 220MCG/INH AER

Facility

$375.33

Service Code	NDC 85134101
Hospital Charge Code	60629954
Hospital Revenue Code	250
Min. Negotiated Rate	$56.30
Max. Negotiated Rate	$56.30
Rate for Payer: Qualcare PPO/HMO/WC	$56.30

MOMETASONE 220MCG/INH AER

Facility

$375.33

Service Code	NDC 85134101
Hospital Charge Code	60629954
Hospital Revenue Code	250
Min. Negotiated Rate	$48.79
Max. Negotiated Rate	$187.66
Rate for Payer: Aetna Commercial	$112.60
Rate for Payer: Aetna Medicare Advantage	$112.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.71
Rate for Payer: Cigna Commercial	$187.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.79
Rate for Payer: Oxford Commercial	$187.66
Rate for Payer: Qualcare PPO/HMO/WC	$56.30
Rate for Payer: UnitedHealthcare Commercial	$187.66

MOMETASONE FUROATE 110MCG

Facility

$1,159.10

Service Code	NDC 85146107
Hospital Charge Code	60635779
Hospital Revenue Code	250
Min. Negotiated Rate	$173.87
Max. Negotiated Rate	$173.87
Rate for Payer: Qualcare PPO/HMO/WC	$173.87

MOMETASONE FUROATE 110MCG

Facility

$1,159.10

Service Code	NDC 85146107
Hospital Charge Code	60635779
Hospital Revenue Code	250
Min. Negotiated Rate	$150.68
Max. Negotiated Rate	$579.55
Rate for Payer: Aetna Commercial	$347.73
Rate for Payer: Aetna Medicare Advantage	$347.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.57
Rate for Payer: Cigna Commercial	$579.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.68
Rate for Payer: Oxford Commercial	$579.55
Rate for Payer: Qualcare PPO/HMO/WC	$173.87
Rate for Payer: UnitedHealthcare Commercial	$579.55

MOMETASONE FUROATE 220MCG

Facility

$355.00

Hospital Charge Code	60635780
Hospital Revenue Code	250
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

Know your out-of-pocket cost for care.

All Charges