Heights University Hospital

All Charges

Charge

Type

Setting

Price

MYCOPHENOLATE SODIUM TAB 180MG

Facility

$30.62

Service Code	HCPCS J7518
Hospital Charge Code	606390560
Hospital Revenue Code	636
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$7.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

MYCOPHENOLIC ACID

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900317
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.12
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.34
Rate for Payer: Cigna Commercial	$24.11
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
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	$24.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.56
Rate for Payer: Wellcare Medicare Advantage	$24.11

MYCOPHENOLIC ACID

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	38472300
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.12
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.34
Rate for Payer: Cigna Commercial	$24.11
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.56
Rate for Payer: Wellcare Medicare Advantage	$24.11

MYCOPHENOLIC ACID

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900317
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOPHENOLIC ACID

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	38472300
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MYCOPHENOLIC ACID 360MG

Facility

$67.00

Service Code	NDC 68084091825
Hospital Charge Code	606390190
Hospital Revenue Code	250
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

MYCOPHENOLIC ACID 360MG

Facility

$67.00

Service Code	NDC 68084091825
Hospital Charge Code	606390190
Hospital Revenue Code	250
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$20.10
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$33.50

MYCOPLASMA IGG/IGM SCREEN

Facility

$108.00

Service Code	HCPCS 86318
Hospital Charge Code	3001021
Hospital Revenue Code	302
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.61
Rate for Payer: Aetna Medicare Advantage	$18.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.28
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: Cigna Medicare Advantage	$9.04
Rate for Payer: Clover Medicare Advantage	$17.19
Rate for Payer: EmblemHealth Commercial	$54.27
Rate for Payer: Humana Medicare Advantage	$18.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.18
Rate for Payer: Wellcare Medicare Advantage	$18.09

MYCOPLASMA IGG/IGM SCREEN

Facility

$108.00

Service Code	HCPCS 86318
Hospital Charge Code	3001021
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

MYCOPLASMA PNEUMONIAE AB IGG

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785B
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	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
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

MYCOPLASMA PNEUMONIAE AB IGG

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785B
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

MYCOPLASMA PNEUMONIAE AB IGM

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785A
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	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
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

MYCOPLASMA PNEUMONIAE AB IGM

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785A
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

MYCOPLASMA PNEUMONIAE CULTURE

Facility

$256.00

Service Code	HCPCS 87109
Hospital Charge Code	3009370
Hospital Revenue Code	309
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

MYCOPLASMA PNEUMONIAE CULTURE

Facility

$256.00

Service Code	HCPCS 87109
Hospital Charge Code	3009370
Hospital Revenue Code	309
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.86
Rate for Payer: Aetna Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.39
Rate for Payer: Cigna Commercial	$15.39
Rate for Payer: Cigna Medicare Advantage	$7.70
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.31
Rate for Payer: Wellcare Medicare Advantage	$15.39

MYCOSTATIN/15GM

Facility

$104.00

Hospital Charge Code	60633475
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

MYCOSTATIN/15GM

Facility

$104.00

Hospital Charge Code	60633475
Hospital Revenue Code	250
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

MYCOSTATIN/500KU/TAB

Facility

$9.51

Service Code	NDC 93098301
Hospital Charge Code	60633476
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

MYCOSTATIN/500KU/TAB

Facility

$9.51

Service Code	NDC 93098301
Hospital Charge Code	60633476
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.43
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$4.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$4.75

MYCOSTATIN VAGINAL/100KU

Facility

$7.00

Hospital Charge Code	60633477
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MYCOSTATIN VAGINAL/100KU

Facility

$7.00

Hospital Charge Code	60633477
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

MYDRIACYL EYE DROPS 2ML

Facility

$26.00

Hospital Charge Code	60635252
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

MYDRIACYL EYE DROPS 2ML

Facility

$26.00

Hospital Charge Code	60635252
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

MYDRIAFAIR 0.5%/15ML

Facility

$28.00

Hospital Charge Code	60634564
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

MYDRIAFAIR 0.5%/15ML

Facility

$28.00

Hospital Charge Code	60634564
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

Know your out-of-pocket cost for care.

All Charges