Heights University Hospital

All Charges

Charge

Type

Setting

Price

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	366893298
Hospital Revenue Code	480
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	7411215
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	366893298
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	7411215
Hospital Revenue Code	480
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

LMA UNIQUE STD SZ 2.5

Facility

$33.30

Hospital Charge Code	270669309
Hospital Revenue Code	272
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$9.99
Rate for Payer: Aetna Medicare Advantage	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.49
Rate for Payer: Cigna Commercial	$16.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.33
Rate for Payer: Oxford Commercial	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.00
Rate for Payer: UnitedHealthcare Commercial	$16.65

LMA UNIQUE STD SZ 2.5

Facility

$33.30

Hospital Charge Code	270669309
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.00

LNG ARM SPLNT SHLDR TO HN

Facility

$777.42

Service Code	HCPCS 29105
Hospital Charge Code	412329105
Hospital Revenue Code	361
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

LNG ARM SPLNT SHLDR TO HN

Facility

$288.00

Service Code	HCPCS 29105
Hospital Charge Code	94186035
Hospital Revenue Code	361
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$86.40
Rate for Payer: Aetna Medicare Advantage	$86.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.44
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	$73.44
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LNG ARM SPLNT SHLDR TO HN

Facility

$777.42

Service Code	HCPCS 29105
Hospital Charge Code	412329105
Hospital Revenue Code	361
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$233.23
Rate for Payer: Aetna Medicare Advantage	$233.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.24
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	$198.24
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.06
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LNG ARM SPLNT SHLDR TO HN

Facility

$288.00

Service Code	HCPCS 29105
Hospital Charge Code	94186035
Hospital Revenue Code	361
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

LN GAS SAMPL 120 MALE DYNJAA04

Facility

$3.20

Hospital Charge Code	270600883
Hospital Revenue Code	270
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

LN GAS SAMPL 120 MALE DYNJAA04

Facility

$3.20

Hospital Charge Code	270600883
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

LNG LG SPLNT THGH TO TOES

Facility

$777.42

Service Code	HCPCS 29505
Hospital Charge Code	412329505
Hospital Revenue Code	361
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

LNG LG SPLNT THGH TO TOES

Facility

$777.42

Service Code	HCPCS 29505
Hospital Charge Code	412329505
Hospital Revenue Code	361
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$233.23
Rate for Payer: Aetna Medicare Advantage	$233.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.24
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	$198.24
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.06
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LNG LG SPLNT THGH TO TOES

Facility

$288.00

Service Code	HCPCS 29505
Hospital Charge Code	94186070
Hospital Revenue Code	361
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

LNG LG SPLNT THGH TO TOES

Facility

$288.00

Service Code	HCPCS 29505
Hospital Charge Code	94186070
Hospital Revenue Code	361
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$86.40
Rate for Payer: Aetna Medicare Advantage	$86.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.44
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	$73.44
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LNR REST ADMMDM X3 INS 28/48E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699503
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

LNR REST ADMMDM X3 INS 28/48E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699503
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

LOADING UNIT GIA60-3.8(BLUE)

Facility

$236.20

Hospital Charge Code	270657208
Hospital Revenue Code	270
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$35.43
Rate for Payer: Qualcare PPO/HMO/WC	$35.43

LOADING UNIT GIA60-3.8(BLUE)

Facility

$236.20

Hospital Charge Code	270657208
Hospital Revenue Code	270
Min. Negotiated Rate	$30.71
Max. Negotiated Rate	$118.10
Rate for Payer: Aetna Commercial	$70.86
Rate for Payer: Aetna Medicare Advantage	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.23
Rate for Payer: Cigna Commercial	$118.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.71
Rate for Payer: Oxford Commercial	$118.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.43
Rate for Payer: UnitedHealthcare Commercial	$118.10

LOAD UNIT 35 2.5 WH TR35W

Facility

$1,310.45

Hospital Charge Code	270608738
Hospital Revenue Code	272
Min. Negotiated Rate	$170.36
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$393.13
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.36
Rate for Payer: Oxford Commercial	$655.23
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$655.23

LOAD UNIT 35 2.5 WH TR35W

Facility

$1,310.45

Hospital Charge Code	270608738
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

LOAD UNIT 35 3.5 BL TR35B

Facility

$1,310.45

Hospital Charge Code	270608736
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

LOAD UNIT 35 3.5 BL TR35B

Facility

$1,310.45

Hospital Charge Code	270608736
Hospital Revenue Code	272
Min. Negotiated Rate	$170.36
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$393.13
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.36
Rate for Payer: Oxford Commercial	$655.23
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$655.23

LOAD UNIT 55 2.5 WH TVR55

Facility

$266.90

Hospital Charge Code	270608734
Hospital Revenue Code	272
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$133.45
Rate for Payer: Aetna Commercial	$80.07
Rate for Payer: Aetna Medicare Advantage	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.06
Rate for Payer: Cigna Commercial	$133.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.70
Rate for Payer: Oxford Commercial	$133.45
Rate for Payer: Qualcare PPO/HMO/WC	$40.03
Rate for Payer: UnitedHealthcare Commercial	$133.45

Know your out-of-pocket cost for care.

All Charges