Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEXAPRO 20MG

Facility

$14.00

Hospital Charge Code	60635552
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$7.00

LEXIVA, 700MG, TAB

Facility

$134.47

Service Code	NDC 49702020718
Hospital Charge Code	60635465
Hospital Revenue Code	250
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.17

LEXIVA, 700MG, TAB

Facility

$134.47

Service Code	NDC 49702020718
Hospital Charge Code	60635465
Hospital Revenue Code	250
Min. Negotiated Rate	$17.48
Max. Negotiated Rate	$67.23
Rate for Payer: Aetna Commercial	$40.34
Rate for Payer: Aetna Medicare Advantage	$40.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.29
Rate for Payer: Cigna Commercial	$67.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.48
Rate for Payer: Oxford Commercial	$67.23
Rate for Payer: Qualcare PPO/HMO/WC	$20.17
Rate for Payer: UnitedHealthcare Commercial	$67.23

LFAN TAB 2MG

Facility

$7.00

Hospital Charge Code	6009286
Hospital Revenue Code	251
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

LFAN TAB 2MG

Facility

$7.00

Hospital Charge Code	6009286
Hospital Revenue Code	251
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LFIT V50 FEMORAL HEAD

Facility

$5,880.00

Hospital Charge Code	270656529
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$1,764.00
Rate for Payer: Aetna Medicare Advantage	$1,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,499.40
Rate for Payer: Cigna Commercial	$2,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

LFIT V50 FEMORAL HEAD

Facility

$5,880.00

Hospital Charge Code	270656529
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,422.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

LG11 AUTOANTIBODY TEST

Facility

$2,575.00

Service Code	HCPCS 86255
Hospital Charge Code	3038555
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$386.25
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$386.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

LG11 AUTOANTIBODY TEST

Facility

$2,575.00

Service Code	HCPCS 86255
Hospital Charge Code	3038555
Hospital Revenue Code	302
Min. Negotiated Rate	$386.25
Max. Negotiated Rate	$386.25
Rate for Payer: Qualcare PPO/HMO/WC	$386.25

LG HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687721
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LG HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687721
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LGN CEMENT STEM 14MMX160MMSTRT

Facility

$12,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270686901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,921.50
Max. Negotiated Rate	$3,100.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50

LGN CEMENT STEM 14MMX160MMSTRT

Facility

$12,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270686901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,921.50
Max. Negotiated Rate	$6,405.00
Rate for Payer: Aetna Commercial	$3,843.00
Rate for Payer: Aetna Medicare Advantage	$3,843.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,562.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,266.55
Rate for Payer: Cigna Commercial	$6,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50

LGN OX CONSTRAINED FEM 5 RT

Facility

$63,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270686900
Hospital Revenue Code	278
Min. Negotiated Rate	$9,515.25
Max. Negotiated Rate	$31,717.50
Rate for Payer: Aetna Commercial	$19,030.50
Rate for Payer: Aetna Medicare Advantage	$19,030.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,175.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,175.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,175.92
Rate for Payer: Cigna Commercial	$31,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,351.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,515.25

LGN OX CONSTRAINED FEM 5 RT

Facility

$63,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270686900
Hospital Revenue Code	278
Min. Negotiated Rate	$9,515.25
Max. Negotiated Rate	$15,351.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,351.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,515.25

LGTIN/BAND ANGIOACCESS AV FSTL

Facility

$25,406.80

Service Code	HCPCS 37607
Hospital Charge Code	16000954
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,622.04
Rate for Payer: Aetna Commercial	$7,622.04
Rate for Payer: Aetna Medicare Advantage	$7,622.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,478.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,478.73
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	$6,478.73
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,302.88
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

LGTIN/BAND ANGIOACCESS AV FSTL

Facility

$25,406.80

Service Code	HCPCS 37607
Hospital Charge Code	16000954
Hospital Revenue Code	360
Min. Negotiated Rate	$3,811.02
Max. Negotiated Rate	$3,811.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02

LGX 15CM 72404256

Facility

$39,115.00

Hospital Charge Code	270659251
Hospital Revenue Code	278
Min. Negotiated Rate	$5,867.25
Max. Negotiated Rate	$19,557.50
Rate for Payer: Aetna Commercial	$11,734.50
Rate for Payer: Aetna Medicare Advantage	$11,734.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,974.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,974.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,823.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,974.33
Rate for Payer: Cigna Commercial	$19,557.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,465.83
Rate for Payer: Qualcare PPO/HMO/WC	$5,867.25

LGX 15CM 72404256

Facility

$39,115.00

Hospital Charge Code	270659251
Hospital Revenue Code	278
Min. Negotiated Rate	$5,867.25
Max. Negotiated Rate	$9,465.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,823.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,465.83
Rate for Payer: Qualcare PPO/HMO/WC	$5,867.25

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	39900415
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.86
Rate for Payer: Cigna Commercial	$18.52
Rate for Payer: Cigna Medicare Advantage	$9.26
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.63
Rate for Payer: Wellcare Medicare Advantage	$18.52

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	39900415
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

LH0 LV CORONARY SVG ANGIO

Facility

$12,026.00

Service Code	HCPCS 93455
Hospital Charge Code	7411223
Hospital Revenue Code	481
Min. Negotiated Rate	$1,563.38
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$3,607.80
Rate for Payer: Aetna Medicare Advantage	$3,607.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,066.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,066.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,066.63
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,563.38
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

LH0 LV CORONARY SVG ANGIO

Facility

$12,026.00

Service Code	HCPCS 93454
Hospital Charge Code	7411219
Hospital Revenue Code	481
Min. Negotiated Rate	$1,803.90
Max. Negotiated Rate	$1,803.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90

LH0 LV CORONARY SVG ANGIO

Facility

$12,026.00

Service Code	HCPCS 93461
Hospital Charge Code	7411243
Hospital Revenue Code	481
Min. Negotiated Rate	$1,803.90
Max. Negotiated Rate	$1,803.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90

LH0 LV CORONARY SVG ANGIO

Facility

$12,026.00

Service Code	HCPCS 93459
Hospital Charge Code	366893459
Hospital Revenue Code	481
Min. Negotiated Rate	$1,803.90
Max. Negotiated Rate	$1,803.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90

Know your out-of-pocket cost for care.

All Charges