Heights University Hospital

All Charges

Charge

Type

Setting

Price

LACTOSE TOLERANCE (BLOOD)***

Facility

$10.00

Service Code	HCPCS 82952
Hospital Charge Code	3007564C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

LACTOSE TOLERANCE (BLOOD)***

Facility

$10.00

Service Code	HCPCS 82952
Hospital Charge Code	3007564B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

LACTOSE TOLERANCE-BLOOD

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3007564A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.16
Rate for Payer: Cigna Commercial	$12.87
Rate for Payer: Cigna Medicare Advantage	$6.43
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.73
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.64
Rate for Payer: Wellcare Medicare Advantage	$12.87

LACTOSE TOLERANCE-BLOOD

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3007564A
Hospital Revenue Code	301
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$45.73
Rate for Payer: Qualcare PPO/HMO/WC	$45.73

LACTULOSE/10GM/15ML

Facility

$15.00

Hospital Charge Code	60633255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

LACTULOSE/10GM/15ML

Facility

$15.00

Hospital Charge Code	60633255
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

LACTULOSE/10GM/15ML

Facility

$13.00

Hospital Charge Code	60633258
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

LACTULOSE/10GM/15ML

Facility

$114.00

Hospital Charge Code	60633256
Hospital Revenue Code	250
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

LACTULOSE/10GM/15ML

Facility

$38.00

Hospital Charge Code	60633257
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

LACTULOSE/10GM/15ML

Facility

$38.00

Hospital Charge Code	60633257
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

LACTULOSE/10GM/15ML

Facility

$114.00

Hospital Charge Code	60633256
Hospital Revenue Code	250
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.82
Rate for Payer: Oxford Commercial	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Commercial	$57.00

LACTULOSE/10GM/15ML

Facility

$13.00

Hospital Charge Code	60633258
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LACTULOSE 10 GM/15 ML SOL

Facility

$11.19

Service Code	NDC 66689003850
Hospital Charge Code	60627892
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Qualcare PPO/HMO/WC	$1.68

LACTULOSE 10 GM/15 ML SOL

Facility

$11.19

Service Code	NDC 66689003850
Hospital Charge Code	60627892
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$5.59
Rate for Payer: Aetna Commercial	$3.36
Rate for Payer: Aetna Medicare Advantage	$3.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.85
Rate for Payer: Cigna Commercial	$5.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.68
Rate for Payer: UnitedHealthcare Commercial	$5.59

LACTULOSE 10 GM/15 ML SYRUP

Facility

$9.25

Service Code	NDC 54868310100
Hospital Charge Code	60627893
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.62
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$4.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$4.62

LACTULOSE 10 GM/15 ML SYRUP

Facility

$9.25

Service Code	NDC 54868310100
Hospital Charge Code	60627893
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

LACTULOSE 10 G REC UD

Facility

$8.65

Hospital Charge Code	60629948
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

LACTULOSE 10 G REC UD

Facility

$8.65

Hospital Charge Code	60629948
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$4.33
Rate for Payer: Aetna Commercial	$2.60
Rate for Payer: Aetna Medicare Advantage	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.21
Rate for Payer: Cigna Commercial	$4.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$4.33

LACTULOSE 15ML U/D

Facility

$7.00

Hospital Charge Code	60635186
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

LACTULOSE 15ML U/D

Facility

$7.00

Hospital Charge Code	60635186
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LACTULOSE SOL 30ML

Facility

$9.00

Hospital Charge Code	6014153
Hospital Revenue Code	251
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

LACTULOSE SOL 30ML

Facility

$9.00

Hospital Charge Code	6014153
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LAGB W HIATAL HERNIA REPAIR

Facility

$53,712.80

Hospital Charge Code	1600161
Hospital Revenue Code	360
Min. Negotiated Rate	$8,056.92
Max. Negotiated Rate	$8,056.92
Rate for Payer: Qualcare PPO/HMO/WC	$8,056.92

LAGB W HIATAL HERNIA REPAIR

Facility

$53,712.80

Hospital Charge Code	1600161
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$26,856.40
Rate for Payer: Aetna Commercial	$16,113.84
Rate for Payer: Aetna Medicare Advantage	$16,113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,696.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,696.76
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	$13,696.76
Rate for Payer: Cigna Commercial	$26,856.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,982.66
Rate for Payer: Qualcare PPO/HMO/WC	$8,056.92

LAG SCREW 10.5MMX115MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705155
Hospital Revenue Code	278
Min. Negotiated Rate	$671.77
Max. Negotiated Rate	$1,083.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: Qualcare PPO/HMO/WC	$671.77

Know your out-of-pocket cost for care.

All Charges