Heights University Hospital

All Charges

Charge

Type

Setting

Price

LOPROSCRW TM SS 2.7X22MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671911
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LOPROSCRW TM SS 2.7X28MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671914
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LOPROSCRW TM SS 2.7X28MMCORTEX

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270671914
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LO RADIATION TX MANAGEMENT

Facility

$1,613.85

Service Code	HCPCS 77469
Hospital Charge Code	85000800
Hospital Revenue Code	333
Min. Negotiated Rate	$242.08
Max. Negotiated Rate	$242.08
Rate for Payer: Qualcare PPO/HMO/WC	$242.08

LO RADIATION TX MANAGEMENT

Facility

$1,613.85

Service Code	HCPCS 77469
Hospital Charge Code	85000800
Hospital Revenue Code	333
Min. Negotiated Rate	$209.80
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$484.15
Rate for Payer: Aetna Medicare Advantage	$484.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.53
Rate for Payer: Cigna Commercial	$289.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.80
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$242.08
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

LORATADINE 10 MG TAB UD

Facility

$5.76

Service Code	NDC 51079024620
Hospital Charge Code	6017792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LORATADINE 10 MG TAB UD

Facility

$5.76

Service Code	NDC 51079024620
Hospital Charge Code	6017792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$2.88

LORAZAPAM

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	39900442
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LORAZAPAM

Facility

$390.00

Service Code	HCPCS 80346
Hospital Charge Code	39900442
Hospital Revenue Code	301
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

LORAZEPAM 0.5 MG TAB

Facility

$4.69

Service Code	NDC 51079041721
Hospital Charge Code	60629823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

LORAZEPAM 0.5 MG TAB

Facility

$4.69

Service Code	NDC 51079041721
Hospital Charge Code	60629823
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.41
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.61
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$2.35

LORAZEPAM 1MG/INJ

Facility

$18.00

Hospital Charge Code	60635014
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

LORAZEPAM 1MG/INJ

Facility

$18.00

Hospital Charge Code	60635014
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

LORAZEPAM 1 MG TAB

Facility

$6.10

Service Code	NDC 51079038620
Hospital Charge Code	6021125
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

LORAZEPAM 1 MG TAB

Facility

$6.10

Service Code	NDC 51079038620
Hospital Charge Code	6021125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

LORAZEPAM 2 MG

Facility

$7.75

Hospital Charge Code	60627846
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.01
Rate for Payer: Oxford Commercial	$3.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.88

LORAZEPAM 2 MG

Facility

$7.75

Hospital Charge Code	60627846
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

LORAZEPAM 2MG/ML 10 ML VIAL

Facility

$6.03

Service Code	HCPCS J2060
Hospital Charge Code	60630218
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LORAZEPAM 2MG/ML 10 ML VIAL

Facility

$6.03

Service Code	HCPCS J2060
Hospital Charge Code	60630218
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.81
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$1.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LORAZEPAM 2 MG/MLINJ.

Facility

$37.30

Hospital Charge Code	60627847
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$18.65
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: Aetna Medicare Advantage	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.51
Rate for Payer: Cigna Commercial	$18.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.85
Rate for Payer: Oxford Commercial	$18.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.59
Rate for Payer: UnitedHealthcare Commercial	$18.65

LORAZEPAM 2 MG/MLINJ.

Facility

$37.30

Hospital Charge Code	60627847
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$5.59

LORAZEPAM 2MG/ML INTENSOL

Facility

$124.00

Hospital Charge Code	60635310
Hospital Revenue Code	250
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

LORAZEPAM 2MG/ML INTENSOL

Facility

$124.00

Hospital Charge Code	60635310
Hospital Revenue Code	250
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$62.00

LORAZEPAM 2 MG/ML SOL

Facility

$40.00

Service Code	HCPCS J2060
Hospital Charge Code	60627845
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

LORAZEPAM 2 MG/ML SOL

Facility

$40.00

Service Code	HCPCS J2060
Hospital Charge Code	60627845
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$1.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges