Heights University Hospital

All Charges

Charge

Type

Setting

Price

MYCOBACTERIUM, BROC CULUT III

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	3990155C
Hospital Revenue Code	309
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

MYCOBACTERIUM, BROC CULUT III

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	3990155C
Hospital Revenue Code	309
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

MYCOBACTERIUM, BROCH CULT I

Facility

$45.90

Service Code	HCPCS 87015
Hospital Charge Code	3990155A
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.88
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

MYCOBACTERIUM, BROCH CULT I

Facility

$45.90

Service Code	HCPCS 87015
Hospital Charge Code	3990155A
Hospital Revenue Code	309
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$6.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.88

MYCOBACTERIUM, BROCHCULUT II

Facility

$73.70

Service Code	HCPCS 87116
Hospital Charge Code	3990155B
Hospital Revenue Code	309
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

MYCOBACTERIUM, BROCHCULUT II

Facility

$73.70

Service Code	HCPCS 87116
Hospital Charge Code	3990155B
Hospital Revenue Code	309
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.99
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.57
Rate for Payer: Cigna Commercial	$10.80
Rate for Payer: Cigna Medicare Advantage	$5.40
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.45
Rate for Payer: Wellcare Medicare Advantage	$10.80

MYCOBACTERIUM ID

Facility

$390.00

Service Code	HCPCS 87118
Hospital Charge Code	39900270
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIUM ID

Facility

$75.20

Service Code	HCPCS 87118
Hospital Charge Code	39900492
Hospital Revenue Code	309
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$114.00
Rate for Payer: Wellcare Medicare Advantage	$14.61
Rate for Payer: Aetna Commercial	$47.34
Rate for Payer: Aetna Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.61
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	$53.53
Rate for Payer: Cigna Commercial	$14.61
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Clover Medicare Advantage	$13.88
Rate for Payer: EmblemHealth Commercial	$43.83
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.28
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.49

MYCOBACTERIUM ID

Facility

$390.00

Service Code	HCPCS 87118
Hospital Charge Code	39900270
Hospital Revenue Code	309
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.34
Rate for Payer: Aetna Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.61
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	$53.53
Rate for Payer: Cigna Commercial	$14.61
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Clover Medicare Advantage	$13.88
Rate for Payer: EmblemHealth Commercial	$43.83
Rate for Payer: Humana Medicare Advantage	$15.05
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	$14.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.49
Rate for Payer: Wellcare Medicare Advantage	$14.61

MYCOBACTERIUM ID

Facility

$75.20

Service Code	HCPCS 87118
Hospital Charge Code	39900492
Hospital Revenue Code	309
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$11.28

MYCOBACTERIUM TUBERCULOSIS COM

Facility

$80.00

Service Code	HCPCS 87556
Hospital Charge Code	397080016
Hospital Revenue Code	306
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

MYCOBACTERIUM TUBERCULOSIS COM

Facility

$80.00

Service Code	HCPCS 87556
Hospital Charge Code	397080016
Hospital Revenue Code	306
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$152.72
Rate for Payer: Aetna Commercial	$135.04
Rate for Payer: Aetna Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.72
Rate for Payer: Cigna Commercial	$41.68
Rate for Payer: Cigna Medicare Advantage	$20.84
Rate for Payer: Clover Medicare Advantage	$39.60
Rate for Payer: EmblemHealth Commercial	$125.04
Rate for Payer: Humana Medicare Advantage	$42.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.18
Rate for Payer: Wellcare Medicare Advantage	$41.68

MYCOB AFB CULT SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479504
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

MYCOB AFB CULT SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479504
Hospital Revenue Code	309
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

MYCOLOG CREAM PACKETS

Facility

$3.00

Hospital Charge Code	60634971
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MYCOLOG CREAM PACKETS

Facility

$3.00

Hospital Charge Code	60634971
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

MYCOLOG OINTMENT PACKETS

Facility

$3.00

Hospital Charge Code	60634972
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MYCOLOG OINTMENT PACKETS

Facility

$3.00

Hospital Charge Code	60634972
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

MYCOPHENOLATE 500 MG INJ

Facility

$730.70

Service Code	NDC 4029809
Hospital Charge Code	60635437
Hospital Revenue Code	250
Min. Negotiated Rate	$109.61
Max. Negotiated Rate	$109.61
Rate for Payer: Qualcare PPO/HMO/WC	$109.61

MYCOPHENOLATE 500 MG INJ

Facility

$730.70

Service Code	NDC 4029809
Hospital Charge Code	60635437
Hospital Revenue Code	250
Min. Negotiated Rate	$94.99
Max. Negotiated Rate	$365.35
Rate for Payer: Aetna Commercial	$219.21
Rate for Payer: Aetna Medicare Advantage	$219.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.33
Rate for Payer: Cigna Commercial	$365.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.99
Rate for Payer: Oxford Commercial	$365.35
Rate for Payer: Qualcare PPO/HMO/WC	$109.61
Rate for Payer: UnitedHealthcare Commercial	$365.35

MYCOPHENOLATE CAP 250MG

Facility

$12.80

Hospital Charge Code	60628663
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

MYCOPHENOLATE CAP 250MG

Facility

$57.42

Service Code	HCPCS J7517
Hospital Charge Code	60628535
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$17.23
Rate for Payer: Aetna Commercial	$17.23
Rate for Payer: Aetna Medicare Advantage	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.64
Rate for Payer: Cigna Commercial	$0.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.61

MYCOPHENOLATE CAP 250MG

Facility

$12.80

Hospital Charge Code	60628663
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

MYCOPHENOLATE CAP 250MG

Facility

$57.42

Service Code	HCPCS J7517
Hospital Charge Code	60628535
Hospital Revenue Code	636
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$13.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.61

MYCOPHENOLATE SODIUM TAB 180MG

Facility

$30.62

Service Code	HCPCS J7518
Hospital Charge Code	606390560
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$9.19
Rate for Payer: Aetna Commercial	$9.19
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$0.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

Know your out-of-pocket cost for care.

All Charges