Heights University Hospital

All Charges

Charge

Type

Setting

Price

LOXAPINE CAP 5MG

Facility

$4.50

Hospital Charge Code	60627810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

LOXAPINE LQ 125MG/5ML 120ML

Facility

$1,224.35

Hospital Charge Code	60627807
Hospital Revenue Code	250
Min. Negotiated Rate	$159.17
Max. Negotiated Rate	$612.17
Rate for Payer: Aetna Commercial	$367.31
Rate for Payer: Aetna Medicare Advantage	$367.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.21
Rate for Payer: Cigna Commercial	$612.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.17
Rate for Payer: Oxford Commercial	$612.17
Rate for Payer: Qualcare PPO/HMO/WC	$183.65
Rate for Payer: UnitedHealthcare Commercial	$612.17

LOXAPINE LQ 125MG/5ML 120ML

Facility

$1,224.35

Hospital Charge Code	60627807
Hospital Revenue Code	250
Min. Negotiated Rate	$183.65
Max. Negotiated Rate	$183.65
Rate for Payer: Qualcare PPO/HMO/WC	$183.65

LOXAPINE SUCCINATE 25 MG CAP

Facility

$10.45

Hospital Charge Code	60627809
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

LOXAPINE SUCCINATE 25 MG CAP

Facility

$10.45

Hospital Charge Code	60627809
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

LOXITANE/10MG/CAP

Facility

$3.00

Hospital Charge Code	60633329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

LOXITANE/10MG/CAP

Facility

$3.00

Hospital Charge Code	60633329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LOXITANE/25MG

Facility

$3.00

Hospital Charge Code	60634786
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LOXITANE/25MG

Facility

$3.00

Hospital Charge Code	60634786
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

LOXITANE/50MG/CAP

Facility

$3.00

Hospital Charge Code	60633330
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

LOXITANE/50MG/CAP

Facility

$3.00

Hospital Charge Code	60633330
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LOXITANE/5MG/CAP

Facility

$3.00

Hospital Charge Code	60633331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

LOXITANE/5MG/CAP

Facility

$3.00

Hospital Charge Code	60633331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LOZOL/2.5MG/TAB

Facility

$4.00

Hospital Charge Code	60633332
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

LOZOL/2.5MG/TAB

Facility

$4.00

Hospital Charge Code	60633332
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LOZOL/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633333
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

LOZOL/2.5MG/TAB

Facility

$4.00

Hospital Charge Code	60633334
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LOZOL/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633333
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LOZOL/2.5MG/TAB

Facility

$4.00

Hospital Charge Code	60633334
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

LPA1231/65 LPA1231/65 ULTIPACE

Facility

$2,000.00

Hospital Charge Code	270705802
Hospital Revenue Code	279
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00

LPA1231/65 LPA1231/65 ULTIPACE

Facility

$2,000.00

Hospital Charge Code	270705802
Hospital Revenue Code	279
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LPD-FLEX ARTICULAR SURFACE

Facility

$5,862.10

Hospital Charge Code	270657958
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

LPD-FLEX ARTICULAR SURFACE

Facility

$5,862.10

Hospital Charge Code	270657958
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

L PLATE 2.3M PRO HD LOCK RI 6H

Facility

$2,725.00

Hospital Charge Code	270669929
Hospital Revenue Code	278
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$659.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

L PLATE 2.3M PRO HD LOCK RI 6H

Facility

$2,725.00

Hospital Charge Code	270669929
Hospital Revenue Code	278
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$1,362.50
Rate for Payer: Aetna Commercial	$817.50
Rate for Payer: Aetna Medicare Advantage	$817.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.88
Rate for Payer: Cigna Commercial	$1,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

Know your out-of-pocket cost for care.

All Charges