Heights University Hospital

All Charges

Charge

Type

Setting

Price

LINEZOLID 2MG/ML (600/300) NS

Facility

$1,255.85

Service Code	NDC 409488301
Hospital Charge Code	606390163
Hospital Revenue Code	250
Min. Negotiated Rate	$188.38
Max. Negotiated Rate	$188.38
Rate for Payer: Qualcare PPO/HMO/WC	$188.38

LINEZOLID 2MG/ML (600/300) NS

Facility

$1,255.85

Service Code	NDC 409488301
Hospital Charge Code	606390163
Hospital Revenue Code	250
Min. Negotiated Rate	$163.26
Max. Negotiated Rate	$627.92
Rate for Payer: Aetna Commercial	$376.75
Rate for Payer: Aetna Medicare Advantage	$376.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.24
Rate for Payer: Cigna Commercial	$627.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.26
Rate for Payer: Oxford Commercial	$627.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.38
Rate for Payer: UnitedHealthcare Commercial	$627.92

LINEZOLID 600 MG/ 300ML

Facility

$1,255.85

Service Code	HCPCS J2020
Hospital Charge Code	60629093
Hospital Revenue Code	636
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$376.75
Rate for Payer: Aetna Commercial	$376.75
Rate for Payer: Aetna Medicare Advantage	$376.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.24
Rate for Payer: Cigna Commercial	$2.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.38

LINEZOLID 600 MG/ 300ML

Facility

$1,255.85

Service Code	HCPCS J2020
Hospital Charge Code	60629093
Hospital Revenue Code	636
Min. Negotiated Rate	$188.38
Max. Negotiated Rate	$303.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.38

LINEZOLID 600 MG TAB

Facility

$1,220.81

Service Code	NDC 9513502
Hospital Charge Code	60629115
Hospital Revenue Code	250
Min. Negotiated Rate	$183.12
Max. Negotiated Rate	$183.12
Rate for Payer: Qualcare PPO/HMO/WC	$183.12

LINEZOLID 600 MG TAB

Facility

$1,220.81

Service Code	NDC 9513502
Hospital Charge Code	60629115
Hospital Revenue Code	250
Min. Negotiated Rate	$158.71
Max. Negotiated Rate	$610.40
Rate for Payer: Aetna Commercial	$366.24
Rate for Payer: Aetna Medicare Advantage	$366.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.31
Rate for Payer: Cigna Commercial	$610.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.71
Rate for Payer: Oxford Commercial	$610.40
Rate for Payer: Qualcare PPO/HMO/WC	$183.12
Rate for Payer: UnitedHealthcare Commercial	$610.40

LIN HI 24x32 RIN LOC 11105924

Facility

$4,285.00

Hospital Charge Code	270639701
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,285.50
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

LIN HI 24x32 RIN LOC 11105924

Facility

$4,285.00

Hospital Charge Code	270639701
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$1,036.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

LINQ RECORDER REMOVAL

Facility

$2,026.92

Service Code	HCPCS 33284
Hospital Charge Code	5100537
Hospital Revenue Code	361
Min. Negotiated Rate	$304.04
Max. Negotiated Rate	$304.04
Rate for Payer: Qualcare PPO/HMO/WC	$304.04

LINQ RECORDER REMOVAL

Facility

$2,026.92

Service Code	HCPCS 33284
Hospital Charge Code	5100537
Hospital Revenue Code	361
Min. Negotiated Rate	$263.50
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$608.08
Rate for Payer: Aetna Medicare Advantage	$608.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.86
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	$516.86
Rate for Payer: Cigna Commercial	$1,013.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.50
Rate for Payer: Qualcare PPO/HMO/WC	$304.04

LINQ SYSTEM INCL DEVICE/MONITR

Facility

$26,475.00

Hospital Charge Code	270677215
Hospital Revenue Code	278
Min. Negotiated Rate	$3,971.25
Max. Negotiated Rate	$6,406.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,406.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,971.25

LINQ SYSTEM INCL DEVICE/MONITR

Facility

$26,475.00

Hospital Charge Code	270677215
Hospital Revenue Code	278
Min. Negotiated Rate	$3,971.25
Max. Negotiated Rate	$13,237.50
Rate for Payer: Aetna Commercial	$7,942.50
Rate for Payer: Aetna Medicare Advantage	$7,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,751.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,751.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,751.12
Rate for Payer: Cigna Commercial	$13,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,406.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,971.25

LINR ARCOM 20mm RNGLC XL105903

Facility

$5,728.85

Hospital Charge Code	270636128
Hospital Revenue Code	278
Min. Negotiated Rate	$859.33
Max. Negotiated Rate	$2,864.43
Rate for Payer: Aetna Commercial	$1,718.65
Rate for Payer: Aetna Medicare Advantage	$1,718.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,460.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,460.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,460.86
Rate for Payer: Cigna Commercial	$2,864.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,386.38
Rate for Payer: Qualcare PPO/HMO/WC	$859.33

LINR ARCOM 20mm RNGLC XL105903

Facility

$5,728.85

Hospital Charge Code	270636128
Hospital Revenue Code	278
Min. Negotiated Rate	$859.33
Max. Negotiated Rate	$1,386.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,386.38
Rate for Payer: Qualcare PPO/HMO/WC	$859.33

LINR SCTION 3000c 65651530

Facility

$8.25

Hospital Charge Code	270301243
Hospital Revenue Code	272
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna Medicare Advantage	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.07
Rate for Payer: Oxford Commercial	$4.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$4.12

LINR SCTION 3000c 65651530

Facility

$8.25

Hospital Charge Code	270301243
Hospital Revenue Code	272
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

LINR VIVACR DM BEAR 28X40MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693906
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

LINR VIVACR DM BEAR 28X40MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693906
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

LIORESAL/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

LIORESAL/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LIORESAL 20MGTAB(BACLOFEN

Facility

$1.00

Hospital Charge Code	60635475
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

LIORESAL 20MGTAB(BACLOFEN

Facility

$1.00

Hospital Charge Code	60635475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

LIOTHYRONINE TAB 25MCG

Facility

$11.93

Service Code	NDC 60793011601
Hospital Charge Code	60628259
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna Commercial	$3.58
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.04
Rate for Payer: Cigna Commercial	$5.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.55
Rate for Payer: Oxford Commercial	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.79
Rate for Payer: UnitedHealthcare Commercial	$5.96

LIOTHYRONINE TAB 25MCG

Facility

$11.93

Service Code	NDC 60793011601
Hospital Charge Code	60628259
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.79

LIOTHYRONINE TAB 5MCG

Facility

$9.11

Service Code	NDC 60793011501
Hospital Charge Code	60628260
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Commercial	$2.73
Rate for Payer: Aetna Medicare Advantage	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.32
Rate for Payer: Cigna Commercial	$4.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.18
Rate for Payer: Oxford Commercial	$4.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.37
Rate for Payer: UnitedHealthcare Commercial	$4.55

Know your out-of-pocket cost for care.

All Charges