Heights University Hospital

All Charges

Charge

Type

Setting

Price

LITHIUM, SERUM

Facility

$667.59

Service Code	HCPCS 80178
Hospital Charge Code	3001856
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LITHIUM, SERUM

Facility

$667.59

Service Code	HCPCS 80178
Hospital Charge Code	3001856
Hospital Revenue Code	301
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.42
Rate for Payer: Aetna Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.22
Rate for Payer: Cigna Commercial	$6.61
Rate for Payer: Cigna Medicare Advantage	$3.31
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.01
Rate for Payer: Wellcare Medicare Advantage	$6.61

LITHLPXY,IN BLAD&REM FRAG,<2.5

Facility

$23,841.70

Service Code	HCPCS 52317
Hospital Charge Code	160000190
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$7,152.51
Rate for Payer: Aetna Medicare Advantage	$7,152.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,079.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,079.63
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	$6,079.63
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,099.42
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

LITHLPXY,IN BLAD&REM FRAG,<2.5

Facility

$23,841.70

Service Code	HCPCS 52317
Hospital Charge Code	160000190
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

LITHOLAPAXY,IN BLAD&REM F>2.5

Facility

$24,549.79

Service Code	HCPCS 52318
Hospital Charge Code	1600000270
Hospital Revenue Code	360
Min. Negotiated Rate	$3,682.47
Max. Negotiated Rate	$3,682.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47

LITHOLAPAXY,IN BLAD&REM F>2.5

Facility

$24,549.79

Service Code	HCPCS 52318
Hospital Charge Code	1600000270
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$7,364.94
Rate for Payer: Aetna Medicare Advantage	$7,364.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,260.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,260.20
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	$6,260.20
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,191.47
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

LITHOPLASTY BDC 7MM X 40CM

Facility

$16,500.00

Hospital Charge Code	270690506
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

LITHOPLASTY BDC 7MM X 40CM

Facility

$16,500.00

Hospital Charge Code	270690506
Hospital Revenue Code	272
Min. Negotiated Rate	$2,145.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,145.00
Rate for Payer: Oxford Commercial	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$8,250.00

LITHOTRIPSY

Facility

$15,223.29

Service Code	HCPCS 50590
Hospital Charge Code	1300011
Hospital Revenue Code	790
Min. Negotiated Rate	$430.73
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$4,566.99
Rate for Payer: Aetna Medicare Advantage	$4,566.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,881.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,881.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$430.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,881.94
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.03
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,283.49
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LITHOTRIPSY

Facility

$15,223.29

Service Code	HCPCS 50590
Hospital Charge Code	1300011
Hospital Revenue Code	790
Min. Negotiated Rate	$2,283.49
Max. Negotiated Rate	$2,283.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,283.49

LITHOTRIPSY***

Facility

$383.00

Hospital Charge Code	2300234
Hospital Revenue Code	759
Min. Negotiated Rate	$49.79
Max. Negotiated Rate	$191.50
Rate for Payer: Aetna Commercial	$114.90
Rate for Payer: Aetna Medicare Advantage	$114.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.67
Rate for Payer: Cigna Commercial	$191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

LITHOTRIPSY***

Facility

$383.00

Hospital Charge Code	2300234
Hospital Revenue Code	759
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

LITHOTRIPTER BASKET

Facility

$458.00

Hospital Charge Code	270325613
Hospital Revenue Code	272
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

LITHOTRIPTER BASKET

Facility

$458.00

Hospital Charge Code	270325613
Hospital Revenue Code	272
Min. Negotiated Rate	$59.54
Max. Negotiated Rate	$229.00
Rate for Payer: Aetna Commercial	$137.40
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.54
Rate for Payer: Oxford Commercial	$229.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$229.00

LITHOTRIPTER MNOLTH 0 MCV 1090

Facility

$2,222.45

Hospital Charge Code	270604774
Hospital Revenue Code	272
Min. Negotiated Rate	$333.37
Max. Negotiated Rate	$333.37
Rate for Payer: Qualcare PPO/HMO/WC	$333.37

LITHOTRIPTER MNOLTH 0 MCV 1090

Facility

$2,222.45

Hospital Charge Code	270604774
Hospital Revenue Code	272
Min. Negotiated Rate	$288.92
Max. Negotiated Rate	$1,111.22
Rate for Payer: Aetna Commercial	$666.74
Rate for Payer: Aetna Medicare Advantage	$666.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$566.72
Rate for Payer: Cigna Commercial	$1,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.92
Rate for Payer: Oxford Commercial	$1,111.22
Rate for Payer: Qualcare PPO/HMO/WC	$333.37
Rate for Payer: UnitedHealthcare Commercial	$1,111.22

LITHOTRIPTER MONLTH 2 MCV 1092

Facility

$2,222.45

Hospital Charge Code	270604776
Hospital Revenue Code	270
Min. Negotiated Rate	$333.37
Max. Negotiated Rate	$333.37
Rate for Payer: Qualcare PPO/HMO/WC	$333.37

LITHOTRIPTER MONLTH 2 MCV 1092

Facility

$2,222.45

Hospital Charge Code	270604776
Hospital Revenue Code	270
Min. Negotiated Rate	$288.92
Max. Negotiated Rate	$1,111.22
Rate for Payer: Aetna Commercial	$666.74
Rate for Payer: Aetna Medicare Advantage	$666.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$566.72
Rate for Payer: Cigna Commercial	$1,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.92
Rate for Payer: Oxford Commercial	$1,111.22
Rate for Payer: Qualcare PPO/HMO/WC	$333.37
Rate for Payer: UnitedHealthcare Commercial	$1,111.22

LIVER ACCESS AND BIOPSY SET

Facility

$2,215.00

Hospital Charge Code	270689191
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$332.25
Rate for Payer: Qualcare PPO/HMO/WC	$332.25

LIVER ACCESS AND BIOPSY SET

Facility

$2,215.00

Hospital Charge Code	270689191
Hospital Revenue Code	272
Min. Negotiated Rate	$287.95
Max. Negotiated Rate	$1,107.50
Rate for Payer: Aetna Commercial	$664.50
Rate for Payer: Aetna Medicare Advantage	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$564.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$564.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$564.83
Rate for Payer: Cigna Commercial	$1,107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.95
Rate for Payer: Oxford Commercial	$1,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$332.25
Rate for Payer: UnitedHealthcare Commercial	$1,107.50

LIVER CYTOSOL (LC-1) ABS

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	38479747
Hospital Revenue Code	302
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.14
Rate for Payer: Aetna Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.31
Rate for Payer: Cigna Commercial	$14.55
Rate for Payer: Cigna Medicare Advantage	$7.28
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.42
Rate for Payer: Wellcare Medicare Advantage	$14.55

LIVER CYTOSOL (LC-1) ABS

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	38479747
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990096A
Hospital Revenue Code	302
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.54
Rate for Payer: Aetna Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.02
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: Cigna Medicare Advantage	$7.64
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.21
Rate for Payer: Wellcare Medicare Advantage	$15.29

LIVER FIBRO,HEPSCORE (TM) I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990096A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) II

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges