Heights University Hospital

All Charges

Charge

Type

Setting

Price

LO IMPLANT 8X10X30MM

Facility

$28,205.00

Hospital Charge Code	270657294
Hospital Revenue Code	278
Min. Negotiated Rate	$4,230.75
Max. Negotiated Rate	$14,102.50
Rate for Payer: Aetna Commercial	$8,461.50
Rate for Payer: Aetna Medicare Advantage	$8,461.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,192.27
Rate for Payer: Cigna Commercial	$14,102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,825.61
Rate for Payer: Qualcare PPO/HMO/WC	$4,230.75

LOKELMA 10 GM

Facility

$174.20

Service Code	NDC 310111039
Hospital Charge Code	606390285
Hospital Revenue Code	250
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Commercial	$52.26
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.42
Rate for Payer: Cigna Commercial	$87.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.65
Rate for Payer: Oxford Commercial	$87.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.13
Rate for Payer: UnitedHealthcare Commercial	$87.10

LOKELMA 10 GM

Facility

$174.20

Service Code	NDC 310111039
Hospital Charge Code	606390285
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$26.13
Rate for Payer: Qualcare PPO/HMO/WC	$26.13

LOKELMA 5 GM

Facility

$174.20

Service Code	NDC 310110539
Hospital Charge Code	606390284
Hospital Revenue Code	250
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Commercial	$52.26
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.42
Rate for Payer: Cigna Commercial	$87.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.65
Rate for Payer: Oxford Commercial	$87.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.13
Rate for Payer: UnitedHealthcare Commercial	$87.10

LOKELMA 5 GM

Facility

$174.20

Service Code	NDC 310110539
Hospital Charge Code	606390284
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$26.13
Rate for Payer: Qualcare PPO/HMO/WC	$26.13

LOMOTIL/60ML

Facility

$48.00

Hospital Charge Code	60633312
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

LOMOTIL/60ML

Facility

$48.00

Hospital Charge Code	60633312
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

LOMOTIL/TAB

Facility

$4.00

Hospital Charge Code	60633313
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

LOMOTIL/TAB

Facility

$4.00

Hospital Charge Code	60633313
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LOMUSTINE 2 CAP 100MG

Facility

$195.85

Hospital Charge Code	6003354
Hospital Revenue Code	251
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.38

LOMUSTINE 2 CAP 100MG

Facility

$195.85

Hospital Charge Code	6003354
Hospital Revenue Code	251
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$97.92
Rate for Payer: Aetna Commercial	$58.76
Rate for Payer: Aetna Medicare Advantage	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$97.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.46
Rate for Payer: Oxford Commercial	$97.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.38
Rate for Payer: UnitedHealthcare Commercial	$97.92

LONG ACTING THYROID STIM****

Facility

$148.00

Hospital Charge Code	3011863
Hospital Revenue Code	309
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

LONG ACTING THYROID STIM****

Facility

$148.00

Hospital Charge Code	3011863
Hospital Revenue Code	309
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

LONG BLADE EXTENDER

Facility

$875.00

Hospital Charge Code	270694230
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.75
Rate for Payer: Oxford Commercial	$437.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$437.50

LONG BLADE EXTENDER

Facility

$875.00

Hospital Charge Code	270694230
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

LONG DRILL 4.3

Facility

$800.00

Hospital Charge Code	270657844
Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$400.00

LONG DRILL 4.3

Facility

$800.00

Hospital Charge Code	270657844
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

longevity dm bearing 28 x 40mm

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270690807
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

longevity dm bearing 28 x 40mm

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270690807
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

LONG FEMUR SCREW

Facility

$357.00

Service Code	HCPCS C1713
Hospital Charge Code	270688192
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.39
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

LONG FEMUR SCREW

Facility

$357.00

Service Code	HCPCS C1713
Hospital Charge Code	270688192
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$86.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.39
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

LONG LEFT PERC PLATE

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270681319
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$1,642.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

LONG LEFT PERC PLATE

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270681319
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

LONG LEG CAST THGH TO TOE

Facility

$618.00

Service Code	HCPCS 29345
Hospital Charge Code	94186050
Hospital Revenue Code	361
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$185.40
Rate for Payer: Aetna Medicare Advantage	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.59
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	$157.59
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LONG LEG CAST THGH TO TOE

Facility

$618.00

Service Code	HCPCS 29345
Hospital Charge Code	94186050
Hospital Revenue Code	361
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

Know your out-of-pocket cost for care.

All Charges