Heights University Hospital

All Charges

Charge

Type

Setting

Price

LAB MISC REF TEST LEVEL 3

Facility

$1,200.00

Hospital Charge Code	3035012
Hospital Revenue Code	300
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

LACERATION TRAY CUSTOM

Facility

$22.08

Hospital Charge Code	270659697
Hospital Revenue Code	272
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$11.04
Rate for Payer: Aetna Commercial	$6.62
Rate for Payer: Aetna Medicare Advantage	$6.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.63
Rate for Payer: Cigna Commercial	$11.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$11.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$11.04

LACERATION TRAY CUSTOM

Facility

$22.08

Hospital Charge Code	270659697
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

LACER LEFT LGE 753-07

Facility

$124.85

Hospital Charge Code	270301164
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

LACER LEFT LGE 753-07

Facility

$124.85

Hospital Charge Code	270301164
Hospital Revenue Code	270
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.23
Rate for Payer: Oxford Commercial	$62.42
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$62.42

LACER LEFT MED 753-05

Facility

$124.85

Hospital Charge Code	270301163
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

LACER LEFT MED 753-05

Facility

$124.85

Hospital Charge Code	270301163
Hospital Revenue Code	270
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.23
Rate for Payer: Oxford Commercial	$62.42
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$62.42

LACER RIGHT LGE 1799-08

Facility

$124.85

Hospital Charge Code	270301161
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

LACER RIGHT LGE 1799-08

Facility

$124.85

Hospital Charge Code	270301161
Hospital Revenue Code	270
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.23
Rate for Payer: Oxford Commercial	$62.42
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$62.42

LACER RIGHT MED 1799-006

Facility

$33.65

Hospital Charge Code	270301162
Hospital Revenue Code	270
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

LACER RIGHT MED 1799-006

Facility

$33.65

Hospital Charge Code	270301162
Hospital Revenue Code	270
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$10.10
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.37
Rate for Payer: Oxford Commercial	$16.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$16.82

LACER WRIST*******

Facility

$41.00

Hospital Charge Code	8002602
Hospital Revenue Code	279
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$20.50
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$20.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$20.50

LACER WRIST*******

Facility

$41.00

Hospital Charge Code	8002602
Hospital Revenue Code	279
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

LAC-HYDRIN 12%/150ML

Facility

$44.00

Hospital Charge Code	60633254
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

LAC-HYDRIN 12%/150ML

Facility

$44.00

Hospital Charge Code	60633254
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

LACOSAMIDE 100 MG TAB

Facility

$83.75

Service Code	NDC 131247835
Hospital Charge Code	6063943364
Hospital Revenue Code	250
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$12.56

LACOSAMIDE 100 MG TAB

Facility

$83.75

Service Code	NDC 131247835
Hospital Charge Code	6063943364
Hospital Revenue Code	250
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$41.88
Rate for Payer: Aetna Commercial	$25.12
Rate for Payer: Aetna Medicare Advantage	$25.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.36
Rate for Payer: Cigna Commercial	$41.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Oxford Commercial	$41.88
Rate for Payer: Qualcare PPO/HMO/WC	$12.56
Rate for Payer: UnitedHealthcare Commercial	$41.88

LACOSAMIDE 10 MG/ML INJ (20ML)

Facility

$439.65

Service Code	HCPCS C9254
Hospital Charge Code	6063943362
Hospital Revenue Code	636
Min. Negotiated Rate	$65.95
Max. Negotiated Rate	$219.82
Rate for Payer: Aetna Commercial	$131.90
Rate for Payer: Aetna Medicare Advantage	$131.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.11
Rate for Payer: Cigna Commercial	$219.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.40
Rate for Payer: Qualcare PPO/HMO/WC	$65.95

LACOSAMIDE 10 MG/ML INJ (20ML)

Facility

$439.65

Service Code	HCPCS C9254
Hospital Charge Code	6063943362
Hospital Revenue Code	636
Min. Negotiated Rate	$65.95
Max. Negotiated Rate	$106.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.40
Rate for Payer: Qualcare PPO/HMO/WC	$65.95

LACOSAMIDE 10MG/ML ORAL SOL

Facility

$44.69

Service Code	NDC 131541071
Hospital Charge Code	6063943367
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$22.34
Rate for Payer: Aetna Commercial	$13.41
Rate for Payer: Aetna Medicare Advantage	$13.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.40
Rate for Payer: Cigna Commercial	$22.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Oxford Commercial	$22.34
Rate for Payer: Qualcare PPO/HMO/WC	$6.70
Rate for Payer: UnitedHealthcare Commercial	$22.34

LACOSAMIDE 10MG/ML ORAL SOL

Facility

$44.69

Service Code	NDC 131541071
Hospital Charge Code	6063943367
Hospital Revenue Code	250
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$6.70

LACOSAMIDE 150 MG TAB

Facility

$88.64

Service Code	NDC 131247935
Hospital Charge Code	6063943365
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$13.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.30

LACOSAMIDE 150 MG TAB

Facility

$88.64

Service Code	NDC 131247935
Hospital Charge Code	6063943365
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$44.32
Rate for Payer: Aetna Commercial	$26.59
Rate for Payer: Aetna Medicare Advantage	$26.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.60
Rate for Payer: Cigna Commercial	$44.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.52
Rate for Payer: Oxford Commercial	$44.32
Rate for Payer: Qualcare PPO/HMO/WC	$13.30
Rate for Payer: UnitedHealthcare Commercial	$44.32

LACOSAMIDE 200 MG TAB

Facility

$88.71

Service Code	NDC 131248035
Hospital Charge Code	6063943366
Hospital Revenue Code	250
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$44.35
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.62
Rate for Payer: Cigna Commercial	$44.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.53
Rate for Payer: Oxford Commercial	$44.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$44.35

LACOSAMIDE 200 MG TAB

Facility

$88.71

Service Code	NDC 131248035
Hospital Charge Code	6063943366
Hospital Revenue Code	250
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

Know your out-of-pocket cost for care.

All Charges