Heights University Hospital

All Charges

Charge

Type

Setting

Price

LIPROPR0TEIN ELECTROPHORESIS I

Facility

$894.84

Service Code	HCPCS 80061
Hospital Charge Code	3001849A
Hospital Revenue Code	301
Min. Negotiated Rate	$134.23
Max. Negotiated Rate	$134.23
Rate for Payer: Qualcare PPO/HMO/WC	$134.23

LIPROPR0TEIN ELECTROPHORESIS I

Facility

$894.84

Service Code	HCPCS 80061
Hospital Charge Code	3001849A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$134.23
Rate for Payer: Aetna Commercial	$43.38
Rate for Payer: Aetna Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.06
Rate for Payer: Cigna Commercial	$13.39
Rate for Payer: Cigna Medicare Advantage	$6.70
Rate for Payer: Clover Medicare Advantage	$12.72
Rate for Payer: EmblemHealth Commercial	$40.17
Rate for Payer: Humana Medicare Advantage	$13.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.23
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.19
Rate for Payer: Wellcare Medicare Advantage	$13.39

LIQUID ADHESIVE

Facility

$15.75

Service Code	NDC 496052348
Hospital Charge Code	60628531
Hospital Revenue Code	250
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.36

LIQUID ADHESIVE

Facility

$15.75

Service Code	NDC 496052348
Hospital Charge Code	60628531
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$7.88
Rate for Payer: Aetna Commercial	$4.72
Rate for Payer: Aetna Medicare Advantage	$4.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.02
Rate for Payer: Cigna Commercial	$7.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.05
Rate for Payer: Oxford Commercial	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.36
Rate for Payer: UnitedHealthcare Commercial	$7.88

Liquid PolibarPlus 1900ml 105%

Facility

$192.55

Hospital Charge Code	6000431
Hospital Revenue Code	250
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$96.28
Rate for Payer: Aetna Commercial	$57.77
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.10
Rate for Payer: Cigna Commercial	$96.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.03
Rate for Payer: Oxford Commercial	$96.28
Rate for Payer: Qualcare PPO/HMO/WC	$28.88
Rate for Payer: UnitedHealthcare Commercial	$96.28

Liquid PolibarPlus 1900ml 105%

Facility

$192.55

Hospital Charge Code	6000431
Hospital Revenue Code	250
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$28.88
Rate for Payer: Qualcare PPO/HMO/WC	$28.88

LIQUID UA CONTROL L III

Facility

$306.45

Hospital Charge Code	270605270
Hospital Revenue Code	272
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$153.22
Rate for Payer: Aetna Commercial	$91.94
Rate for Payer: Aetna Medicare Advantage	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.14
Rate for Payer: Cigna Commercial	$153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.84
Rate for Payer: Oxford Commercial	$153.22
Rate for Payer: Qualcare PPO/HMO/WC	$45.97
Rate for Payer: UnitedHealthcare Commercial	$153.22

LIQUID UA CONTROL L III

Facility

$306.45

Hospital Charge Code	270605270
Hospital Revenue Code	272
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$45.97
Rate for Payer: Qualcare PPO/HMO/WC	$45.97

LISDEXAMFETAMINE DIMESYLATE 20

Facility

$38.19

Service Code	NDC 59417010210
Hospital Charge Code	6063943214
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.73

LISDEXAMFETAMINE DIMESYLATE 20

Facility

$38.19

Service Code	NDC 59417010210
Hospital Charge Code	6063943214
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.74
Rate for Payer: Cigna Commercial	$19.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.96
Rate for Payer: Oxford Commercial	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$19.09

LISDEXAMFETAMINE DIMESYLATE 30

Facility

$38.19

Service Code	NDC 59417010310
Hospital Charge Code	6063943215
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.74
Rate for Payer: Cigna Commercial	$19.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.96
Rate for Payer: Oxford Commercial	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$19.09

LISDEXAMFETAMINE DIMESYLATE 30

Facility

$38.19

Service Code	NDC 59417010310
Hospital Charge Code	6063943215
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.73

LISFRANC PLATE LG LEFT

Facility

$4,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270702068
Hospital Revenue Code	278
Min. Negotiated Rate	$618.00
Max. Negotiated Rate	$2,060.00
Rate for Payer: Aetna Commercial	$1,236.00
Rate for Payer: Aetna Medicare Advantage	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$824.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,050.60
Rate for Payer: Cigna Commercial	$2,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$997.04
Rate for Payer: Qualcare PPO/HMO/WC	$618.00

LISFRANC PLATE LG LEFT

Facility

$4,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270702068
Hospital Revenue Code	278
Min. Negotiated Rate	$618.00
Max. Negotiated Rate	$997.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$824.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$997.04
Rate for Payer: Qualcare PPO/HMO/WC	$618.00

LISINOPRIL 10 MG TAB

Facility

$6.30

Service Code	NDC 51079098220
Hospital Charge Code	60627572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

LISINOPRIL 10 MG TAB

Facility

$6.30

Service Code	NDC 51079098220
Hospital Charge Code	60627572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.15
Rate for Payer: Aetna Commercial	$1.89
Rate for Payer: Aetna Medicare Advantage	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.61
Rate for Payer: Cigna Commercial	$3.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.82
Rate for Payer: Oxford Commercial	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$3.15

LISINOPRIL 20 MG TAB

Facility

$6.77

Service Code	NDC 51079098320
Hospital Charge Code	60627573
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

LISINOPRIL 20 MG TAB

Facility

$6.77

Service Code	NDC 51079098320
Hospital Charge Code	60627573
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.03
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.73
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.88
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$3.38

LISINOPRIL 2.5 MG TAB

Facility

$4.36

Service Code	NDC 68180051201
Hospital Charge Code	60629826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.31
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.57
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$2.18

LISINOPRIL 2.5 MG TAB

Facility

$4.36

Service Code	NDC 68180051201
Hospital Charge Code	60629826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

LISINOPRIL 2.5MG TAB

Facility

$2.60

Hospital Charge Code	606293243
Hospital Revenue Code	251
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Commercial	$0.78
Rate for Payer: Aetna Medicare Advantage	$0.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.66
Rate for Payer: Cigna Commercial	$1.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.34
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.39
Rate for Payer: UnitedHealthcare Commercial	$1.30

LISINOPRIL 2.5MG TAB

Facility

$2.60

Hospital Charge Code	606293243
Hospital Revenue Code	251
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.39

LISINOPRIL 5 MG TAB

Facility

$6.10

Service Code	NDC 51079098120
Hospital Charge Code	60627574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare Advantage	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.56
Rate for Payer: Cigna Commercial	$3.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Oxford Commercial	$3.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$3.05

LISINOPRIL 5 MG TAB

Facility

$6.10

Service Code	NDC 51079098120
Hospital Charge Code	60627574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

LISPRO INSULIN 75/25 U-100 INJ

Facility

$1,849.20

Service Code	NDC 2751101
Hospital Charge Code	60629167
Hospital Revenue Code	250
Min. Negotiated Rate	$277.38
Max. Negotiated Rate	$277.38
Rate for Payer: Qualcare PPO/HMO/WC	$277.38

Know your out-of-pocket cost for care.

All Charges