Heights University Hospital

All Charges

Charge

Type

Setting

Price

LOTRIMIN 1%/30ML

Facility

$42.00

Hospital Charge Code	60633326
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

LOTRIMIN 1%/30ML

Facility

$42.00

Hospital Charge Code	60633326
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$21.00

LOTRISONE/15GM

Facility

$104.00

Hospital Charge Code	60633328
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

LOTRISONE/15GM

Facility

$104.00

Hospital Charge Code	60633328
Hospital Revenue Code	250
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

LOTRISONE CREAM 45 GM

Facility

$125.00

Hospital Charge Code	60635228
Hospital Revenue Code	250
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

LOTRISONE CREAM 45 GM

Facility

$125.00

Hospital Charge Code	60635228
Hospital Revenue Code	250
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

LOVASTATIN 20 MG TAB

Facility

$18.45

Hospital Charge Code	6008593
Hospital Revenue Code	252
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.22
Rate for Payer: UnitedHealthcare Commercial	$9.22

LOVASTATIN 20 MG TAB

Facility

$18.45

Hospital Charge Code	6008593
Hospital Revenue Code	252
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

LOVAZA CAP

Facility

$79.93

Service Code	NDC 80725042012
Hospital Charge Code	60632240
Hospital Revenue Code	250
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$11.99
Rate for Payer: Qualcare PPO/HMO/WC	$11.99

LOVAZA CAP

Facility

$79.93

Service Code	NDC 80725042012
Hospital Charge Code	60632240
Hospital Revenue Code	250
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$39.97
Rate for Payer: Aetna Commercial	$23.98
Rate for Payer: Aetna Medicare Advantage	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.38
Rate for Payer: Cigna Commercial	$39.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.39
Rate for Payer: Oxford Commercial	$39.97
Rate for Payer: Qualcare PPO/HMO/WC	$11.99
Rate for Payer: UnitedHealthcare Commercial	$39.97

LOVENOX 100MG/ML 300GVIAL

Facility

$608.00

Hospital Charge Code	60635526
Hospital Revenue Code	636
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$147.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.20

LOVENOX 100MG/ML 300GVIAL

Facility

$608.00

Hospital Charge Code	60635526
Hospital Revenue Code	636
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$304.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.04
Rate for Payer: Cigna Commercial	$304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.20

LOW BACK,DISK SURGERY

Facility

$47,548.90

Service Code	HCPCS 63030
Hospital Charge Code	16000289
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Aetna Commercial	$14,264.67
Rate for Payer: Aetna Medicare Advantage	$14,264.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,124.97
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	$12,124.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,181.36
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LOW BACK,DISK SURGERY

Facility

$47,548.90

Service Code	HCPCS 63030
Hospital Charge Code	16000289
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

LOW CNT 150 TO 199 PER ML

Facility

$8.00

Hospital Charge Code	2009395
Hospital Revenue Code	255
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LOW CNT 150 TO 199 PER ML

Facility

$8.00

Hospital Charge Code	2009395
Hospital Revenue Code	255
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

LOW CONT 1 TO 199 PER ML

Facility

$8.00

Hospital Charge Code	2009400
Hospital Revenue Code	255
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LOW CONT 1 TO 199 PER ML

Facility

$8.00

Hospital Charge Code	2009400
Hospital Revenue Code	255
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

LOW DENSITY LIPOPROTEIN (LDL)

Facility

$85.00

Service Code	HCPCS 83721
Hospital Charge Code	38472464
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.02
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.47
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: Cigna Medicare Advantage	$5.25
Rate for Payer: Clover Medicare Advantage	$9.97
Rate for Payer: EmblemHealth Commercial	$31.50
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.13
Rate for Payer: Wellcare Medicare Advantage	$10.50

LOW DENSITY LIPOPROTEIN (LDL)

Facility

$85.00

Service Code	HCPCS 83721
Hospital Charge Code	38472464
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$85,516.99

Service Code	MSDRG 493
Min. Negotiated Rate	$27,054.22
Max. Negotiated Rate	$85,516.99
Rate for Payer: Aetna Commercial	$85,516.99
Rate for Payer: Aetna Medicare Advantage	$27,675.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66,160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66,160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,478.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66,160.80
Rate for Payer: Cigna Commercial	$54,579.41
Rate for Payer: Cigna Medicare Advantage	$28,478.13
Rate for Payer: Clover Medicare Advantage	$27,054.22
Rate for Payer: EmblemHealth Commercial	$85,434.39
Rate for Payer: Humana Medicare Advantage	$29,332.47
Rate for Payer: Oxford Commercial	$34,110.54
Rate for Payer: UnitedHealthcare Commercial	$38,718.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,478.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$30,186.82
Rate for Payer: Wellcare Medicare Advantage	$28,478.13

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$123,805.92

Service Code	MSDRG 492
Min. Negotiated Rate	$37,491.16
Max. Negotiated Rate	$123,805.92
Rate for Payer: Aetna Commercial	$123,805.92
Rate for Payer: Aetna Medicare Advantage	$40,066.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95,381.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95,381.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$39,464.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95,381.82
Rate for Payer: Cigna Commercial	$79,016.50
Rate for Payer: Cigna Medicare Advantage	$39,464.38
Rate for Payer: Clover Medicare Advantage	$37,491.16
Rate for Payer: EmblemHealth Commercial	$118,393.14
Rate for Payer: Humana Medicare Advantage	$40,648.31
Rate for Payer: Oxford Commercial	$49,383.02
Rate for Payer: UnitedHealthcare Commercial	$56,054.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$39,464.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$41,832.24
Rate for Payer: Wellcare Medicare Advantage	$39,464.38

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$70,062.36

Service Code	MSDRG 494
Min. Negotiated Rate	$21,896.10
Max. Negotiated Rate	$70,062.36
Rate for Payer: Aetna Commercial	$67,658.95
Rate for Payer: Aetna Medicare Advantage	$21,896.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,550.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,550.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,354.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,550.29
Rate for Payer: Cigna Commercial	$43,181.89
Rate for Payer: Cigna Medicare Advantage	$23,354.12
Rate for Payer: Clover Medicare Advantage	$22,186.41
Rate for Payer: EmblemHealth Commercial	$70,062.36
Rate for Payer: Humana Medicare Advantage	$24,054.74
Rate for Payer: Oxford Commercial	$26,987.42
Rate for Payer: UnitedHealthcare Commercial	$30,633.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,354.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24,755.37
Rate for Payer: Wellcare Medicare Advantage	$23,354.12

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$68,231.88

Service Code	APR-DRG 1814
Min. Negotiated Rate	$56,852.58
Max. Negotiated Rate	$68,231.88
Rate for Payer: Aetna Better Health Medicaid	$66,894.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$68,231.88
Rate for Payer: Wellpoint Medicaid Managed Care	$56,852.58

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$29,230.81

Service Code	APR-DRG 1812
Min. Negotiated Rate	$19,219.79
Max. Negotiated Rate	$29,230.81
Rate for Payer: Aetna Better Health Medicaid	$28,657.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$29,230.81
Rate for Payer: Wellpoint Medicaid Managed Care	$19,219.79

Know your out-of-pocket cost for care.

All Charges