Heights University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE W/GLUC INJ 5%

Facility

$19.85

Hospital Charge Code	6003255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

LIDOCAINE W/GLUC INJ 5%

Facility

$19.85

Hospital Charge Code	6003255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

LIDOCIANE VIAL 2%

Facility

$3.85

Hospital Charge Code	6014138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

LIDOCIANE VIAL 2%

Facility

$3.85

Hospital Charge Code	6014138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

LIDO/PRILO CREAM (5GM)

Facility

$53.87

Service Code	NDC 115146860
Hospital Charge Code	6063943126
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$26.93
Rate for Payer: Aetna Commercial	$16.16
Rate for Payer: Aetna Medicare Advantage	$16.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.74
Rate for Payer: Cigna Commercial	$26.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.00
Rate for Payer: Oxford Commercial	$26.93
Rate for Payer: Qualcare PPO/HMO/WC	$8.08
Rate for Payer: UnitedHealthcare Commercial	$26.93

LIDO/PRILO CREAM (5GM)

Facility

$53.87

Service Code	NDC 115146860
Hospital Charge Code	6063943126
Hospital Revenue Code	250
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$8.08
Rate for Payer: Qualcare PPO/HMO/WC	$8.08

LIF AMP BONE SCREW 5.5X45MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706235
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LIF AMP BONE SCREW 5.5X45MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706235
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LIFAMP ONE SCREW PLATE 04 W CE

Facility

$15,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270706234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,302.50
Max. Negotiated Rate	$7,675.00
Rate for Payer: Aetna Commercial	$4,605.00
Rate for Payer: Aetna Medicare Advantage	$4,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,914.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,914.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,914.25
Rate for Payer: Cigna Commercial	$7,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,714.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,302.50

LIFAMP ONE SCREW PLATE 04 W CE

Facility

$15,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270706234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,302.50
Max. Negotiated Rate	$3,714.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,714.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,302.50

LIFE PORT IMPLANT (BARD)

Facility

$975.00

Service Code	HCPCS C1788
Hospital Charge Code	270658505
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

LIFE PORT IMPLANT (BARD)

Facility

$975.00

Service Code	HCPCS C1788
Hospital Charge Code	270658505
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

LIFE PORT INFUSION SET

Facility

$14.00

Service Code	HCPCS 99999
Hospital Charge Code	3400199
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

LIFE PORT INFUSION SET

Facility

$14.00

Service Code	HCPCS 99999
Hospital Charge Code	3400199
Hospital Revenue Code	272
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

LIFEPORT INFUSION SET W/Y-SITE

Facility

$38.00

Hospital Charge Code	270331909
Hospital Revenue Code	272
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

LIFEPORT INFUSION SET W/Y-SITE

Facility

$38.00

Hospital Charge Code	270331909
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

LIFEPORT POWER IMPLANT (BARD)

Facility

$2,010.00

Service Code	HCPCS C1788
Hospital Charge Code	270650771
Hospital Revenue Code	278
Min. Negotiated Rate	$301.50
Max. Negotiated Rate	$1,005.00
Rate for Payer: Aetna Commercial	$603.00
Rate for Payer: Aetna Medicare Advantage	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.55
Rate for Payer: Cigna Commercial	$1,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: Qualcare PPO/HMO/WC	$301.50

LIFEPORT POWER IMPLANT (BARD)

Facility

$2,010.00

Service Code	HCPCS C1788
Hospital Charge Code	270650771
Hospital Revenue Code	278
Min. Negotiated Rate	$301.50
Max. Negotiated Rate	$486.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: Qualcare PPO/HMO/WC	$301.50

LIFEPORT X-PORT ISP

Facility

$1,250.00

Hospital Charge Code	270660381
Hospital Revenue Code	270
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

LIFEPORT X-PORT ISP

Facility

$1,250.00

Hospital Charge Code	270660381
Hospital Revenue Code	270
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

LIF GUIDEWIRE

Facility

$383.75

Hospital Charge Code	270702576
Hospital Revenue Code	278
Min. Negotiated Rate	$57.56
Max. Negotiated Rate	$92.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.87
Rate for Payer: Qualcare PPO/HMO/WC	$57.56

LIF GUIDEWIRE

Facility

$383.75

Hospital Charge Code	270702576
Hospital Revenue Code	278
Min. Negotiated Rate	$57.56
Max. Negotiated Rate	$191.88
Rate for Payer: Aetna Commercial	$115.12
Rate for Payer: Aetna Medicare Advantage	$115.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.86
Rate for Payer: Cigna Commercial	$191.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.87
Rate for Payer: Qualcare PPO/HMO/WC	$57.56

LIGACLIP APPLIER

Facility

$101.00

Hospital Charge Code	270338713
Hospital Revenue Code	272
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$50.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$50.50

LIGACLIP APPLIER

Facility

$101.00

Hospital Charge Code	270338713
Hospital Revenue Code	272
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

LIGACLIP APPLIER 5MM

Facility

$1,924.30

Hospital Charge Code	270655946
Hospital Revenue Code	272
Min. Negotiated Rate	$288.64
Max. Negotiated Rate	$288.64
Rate for Payer: Qualcare PPO/HMO/WC	$288.64

Know your out-of-pocket cost for care.

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