Heights University Hospital

All Charges

Charge

Type

Setting

Price

MY KNEE 2R MEDIAL

Facility

$500.00

Hospital Charge Code	270685304
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

MY KNEE 2R MEDIAL

Facility

$500.00

Hospital Charge Code	270685304
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE FEM RM#4

Facility

$625.00

Hospital Charge Code	270687439
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MYKNEE FEM RM#4

Facility

$625.00

Hospital Charge Code	270687439
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$625.00

Hospital Charge Code	270682050
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270675745
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270675745
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$625.00

Hospital Charge Code	270682050
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MY KNEE TIBIAL CUT BLOCK

Facility

$625.00

Hospital Charge Code	270681471
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MY KNEE TIBIAL CUT BLOCK

Facility

$625.00

Hospital Charge Code	270681471
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

MYLERAN 2MG TAB

Facility

$5.00

Hospital Charge Code	60635375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MYLERAN 2MG TAB

Facility

$5.00

Hospital Charge Code	60635375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MYLICON 40

Facility

$3.00

Hospital Charge Code	60634486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MYLICON 40

Facility

$3.00

Hospital Charge Code	60634486
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

MYLICON/40MG/0.6ML

Facility

$19.00

Hospital Charge Code	60633478
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

MYLICON/40MG/0.6ML

Facility

$19.00

Hospital Charge Code	60633478
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

MYLICON 80

Facility

$1.00

Hospital Charge Code	60634487
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

MYLICON 80

Facility

$1.00

Hospital Charge Code	60634487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

MYLOTARG 5MG VIAL

Facility

$12,661.00

Hospital Charge Code	60635573
Hospital Revenue Code	636
Min. Negotiated Rate	$1,899.15
Max. Negotiated Rate	$3,063.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,063.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.15

MYLOTARG 5MG VIAL

Facility

$12,661.00

Hospital Charge Code	60635573
Hospital Revenue Code	636
Min. Negotiated Rate	$1,899.15
Max. Negotiated Rate	$6,330.50
Rate for Payer: Aetna Commercial	$3,798.30
Rate for Payer: Aetna Medicare Advantage	$3,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,228.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,228.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,228.55
Rate for Payer: Cigna Commercial	$6,330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,063.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.15

MYLOTARG 5MG VIAL 20ML

Facility

$5,574.00

Hospital Charge Code	60635359
Hospital Revenue Code	636
Min. Negotiated Rate	$836.10
Max. Negotiated Rate	$1,348.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,348.91
Rate for Payer: Qualcare PPO/HMO/WC	$836.10

MYLOTARG 5MG VIAL 20ML

Facility

$5,574.00

Hospital Charge Code	60635359
Hospital Revenue Code	636
Min. Negotiated Rate	$836.10
Max. Negotiated Rate	$2,787.00
Rate for Payer: Aetna Commercial	$1,672.20
Rate for Payer: Aetna Medicare Advantage	$1,672.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,421.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,421.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,421.37
Rate for Payer: Cigna Commercial	$2,787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,348.91
Rate for Payer: Qualcare PPO/HMO/WC	$836.10

MYNGTM INCL ASP/EUSTACH INFLAT

Facility

$14,464.70

Service Code	HCPCS 69421
Hospital Charge Code	16001046
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$4,339.41
Rate for Payer: Aetna Medicare Advantage	$4,339.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,688.50
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	$3,688.50
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,880.41
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,169.70
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

MYNGTM INCL ASP/EUSTACH INFLAT

Facility

$14,464.70

Service Code	HCPCS 69421
Hospital Charge Code	16001046
Hospital Revenue Code	360
Min. Negotiated Rate	$2,169.70
Max. Negotiated Rate	$2,169.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,169.70

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,416.25

Service Code	HCPCS C1760
Hospital Charge Code	270662371N
Hospital Revenue Code	278
Min. Negotiated Rate	$212.44
Max. Negotiated Rate	$708.12
Rate for Payer: Aetna Commercial	$424.88
Rate for Payer: Aetna Medicare Advantage	$424.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.14
Rate for Payer: Cigna Commercial	$708.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$212.44

Know your out-of-pocket cost for care.

All Charges