Heights University Hospital

All Charges

Charge

Type

Setting

Price

MOUTHGUARD RUBBER EMGD

Facility

$181.65

Hospital Charge Code	270616361
Hospital Revenue Code	270
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$90.83
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$90.83
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$90.83

MOUTHGUARD RUBBER EMGD

Facility

$181.65

Hospital Charge Code	270616361
Hospital Revenue Code	270
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

MOUTHPIECE CARDBRD 022417

Facility

$2.45

Hospital Charge Code	270606149
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

MOUTHPIECE CARDBRD 022417

Facility

$2.45

Hospital Charge Code	270606149
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

MOUTHPIECE TUBING 7FT. 02

Facility

$5.31

Hospital Charge Code	270648269
Hospital Revenue Code	272
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$1.59
Rate for Payer: Aetna Medicare Advantage	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.69
Rate for Payer: Oxford Commercial	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.65

MOUTHPIECE TUBING 7FT. 02

Facility

$5.31

Hospital Charge Code	270648269
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

MOUTH PROCEDURES WITH CC/MCC

Facility

$55,163.46

Service Code	MSDRG 137
Min. Negotiated Rate	$16,294.67
Max. Negotiated Rate	$55,163.46
Rate for Payer: Aetna Commercial	$50,350.53
Rate for Payer: Aetna Medicare Advantage	$16,294.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,350.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,350.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,387.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,350.50
Rate for Payer: Cigna Commercial	$32,135.16
Rate for Payer: Cigna Medicare Advantage	$18,387.82
Rate for Payer: Clover Medicare Advantage	$17,468.43
Rate for Payer: EmblemHealth Commercial	$55,163.46
Rate for Payer: Humana Medicare Advantage	$18,939.45
Rate for Payer: Oxford Commercial	$20,083.54
Rate for Payer: UnitedHealthcare Commercial	$22,796.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,387.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19,491.09
Rate for Payer: Wellcare Medicare Advantage	$18,387.82

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$37,544.82

Service Code	MSDRG 138
Min. Negotiated Rate	$9,670.73
Max. Negotiated Rate	$37,544.82
Rate for Payer: Aetna Commercial	$29,882.56
Rate for Payer: Aetna Medicare Advantage	$9,670.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,983.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,983.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,514.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,983.29
Rate for Payer: Cigna Commercial	$19,071.91
Rate for Payer: Cigna Medicare Advantage	$12,514.94
Rate for Payer: Clover Medicare Advantage	$11,889.19
Rate for Payer: EmblemHealth Commercial	$37,544.82
Rate for Payer: Humana Medicare Advantage	$12,890.39
Rate for Payer: Oxford Commercial	$11,919.39
Rate for Payer: UnitedHealthcare Commercial	$13,529.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,514.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13,265.84
Rate for Payer: Wellcare Medicare Advantage	$12,514.94

MOUTHWASH APRILFRESH

Facility

$4.00

Hospital Charge Code	270301253
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MOUTHWASH APRILFRESH

Facility

$4.00

Hospital Charge Code	270301253
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

MOXAN PLATE

Facility

$11,455.00

Hospital Charge Code	270656605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,718.25
Max. Negotiated Rate	$5,727.50
Rate for Payer: Aetna Commercial	$3,436.50
Rate for Payer: Aetna Medicare Advantage	$3,436.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,921.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,921.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,921.03
Rate for Payer: Cigna Commercial	$5,727.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,718.25

MOXAN PLATE

Facility

$11,455.00

Hospital Charge Code	270656605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,718.25
Max. Negotiated Rate	$2,772.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,291.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,718.25

MOXIFLOXACIN 400 MG/ 250 ML

Facility

$293.13

Service Code	HCPCS J2280
Hospital Charge Code	60629222
Hospital Revenue Code	636
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$87.94
Rate for Payer: Aetna Commercial	$87.94
Rate for Payer: Aetna Medicare Advantage	$87.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.75
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.94
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

MOXIFLOXACIN 400 MG/ 250 ML

Facility

$293.13

Service Code	HCPCS J2280
Hospital Charge Code	60629222
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$70.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.94
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

MOXIFLOXACIN 400 MG TAB

Facility

$222.71

Service Code	NDC 50419053001
Hospital Charge Code	60629231
Hospital Revenue Code	250
Min. Negotiated Rate	$33.41
Max. Negotiated Rate	$33.41
Rate for Payer: Qualcare PPO/HMO/WC	$33.41

MOXIFLOXACIN 400 MG TAB

Facility

$222.71

Service Code	NDC 50419053001
Hospital Charge Code	60629231
Hospital Revenue Code	250
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$111.36
Rate for Payer: Aetna Commercial	$66.81
Rate for Payer: Aetna Medicare Advantage	$66.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.79
Rate for Payer: Cigna Commercial	$111.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.95
Rate for Payer: Oxford Commercial	$111.36
Rate for Payer: Qualcare PPO/HMO/WC	$33.41
Rate for Payer: UnitedHealthcare Commercial	$111.36

M.PNEUMONIAE AB (IGG),EIA

Facility

$667.59

Service Code	HCPCS 86738
Hospital Charge Code	39900250
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M.PNEUMONIAE AB (IGG),EIA

Facility

$667.59

Service Code	HCPCS 86738
Hospital Charge Code	39900250
Hospital Revenue Code	302
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
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	$48.51
Rate for Payer: Cigna Commercial	$13.24
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
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	$13.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.03
Rate for Payer: Wellcare Medicare Advantage	$13.24

M.PNEUMONIAE AB (IGG,M),E I

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046A
Hospital Revenue Code	302
Min. Negotiated Rate	$86.79
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$200.28
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
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

M.PNEUMONIAE AB (IGG,M),E I

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M.PNEUMONIAE AB (IGG,M),E II

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046B
Hospital Revenue Code	302
Min. Negotiated Rate	$86.79
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$200.28
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
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

M.PNEUMONIAE AB (IGG,M),E II

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M. PNEUMONIAE ANTIBODY AI

Facility

$79.19

Service Code	HCPCS 86738
Hospital Charge Code	39900533
Hospital Revenue Code	302
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

M. PNEUMONIAE ANTIBODY AI

Facility

$79.19

Service Code	HCPCS 86738
Hospital Charge Code	39900533
Hospital Revenue Code	302
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: Aetna Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
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	$48.51
Rate for Payer: Cigna Commercial	$13.24
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.03
Rate for Payer: Wellcare Medicare Advantage	$13.24

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900269
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

Know your out-of-pocket cost for care.

All Charges