Heights University Hospital

All Charges

Charge

Type

Setting

Price

LP NON LOCK 2.7MM X 16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701901
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON-LOCK 2.7MM X 22MM

Facility

$595.00

Hospital Charge Code	270663846
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$178.50
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON-LOCK 2.7MM X 22MM

Facility

$595.00

Hospital Charge Code	270663846
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 24MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701902
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 24MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701902
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$178.50
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 26MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701899
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 26MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701899
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$178.50
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP-PLA2

Facility

$286.00

Service Code	HCPCS 83698
Hospital Charge Code	38474062
Hospital Revenue Code	301
Min. Negotiated Rate	$23.16
Max. Negotiated Rate	$169.68
Rate for Payer: Aetna Commercial	$150.04
Rate for Payer: Aetna Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.68
Rate for Payer: Cigna Commercial	$46.31
Rate for Payer: Cigna Medicare Advantage	$23.16
Rate for Payer: Clover Medicare Advantage	$43.99
Rate for Payer: EmblemHealth Commercial	$138.93
Rate for Payer: Humana Medicare Advantage	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$49.09
Rate for Payer: Wellcare Medicare Advantage	$46.31

LP-PLA2

Facility

$240.40

Service Code	HCPCS 83698
Hospital Charge Code	38477189
Hospital Revenue Code	301
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$36.06
Rate for Payer: Qualcare PPO/HMO/WC	$36.06

LP-PLA2

Facility

$286.00

Service Code	HCPCS 83698
Hospital Charge Code	38474062
Hospital Revenue Code	301
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

LP-PLA2

Facility

$240.40

Service Code	HCPCS 83698
Hospital Charge Code	38477189
Hospital Revenue Code	301
Min. Negotiated Rate	$23.16
Max. Negotiated Rate	$169.68
Rate for Payer: Aetna Commercial	$150.04
Rate for Payer: Aetna Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.68
Rate for Payer: Cigna Commercial	$46.31
Rate for Payer: Cigna Medicare Advantage	$23.16
Rate for Payer: Clover Medicare Advantage	$43.99
Rate for Payer: EmblemHealth Commercial	$138.93
Rate for Payer: Humana Medicare Advantage	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.06
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$49.09
Rate for Payer: Wellcare Medicare Advantage	$46.31

LPR-VAG HYST INCL T/O =<250 GM

Facility

$43,337.60

Service Code	HCPCS 58552
Hospital Charge Code	16001007
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$13,001.28
Rate for Payer: Aetna Medicare Advantage	$13,001.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,051.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,051.09
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	$11,051.09
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,633.89
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.64
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LPR-VAG HYST INCL T/O =<250 GM

Facility

$43,337.60

Service Code	HCPCS 58552
Hospital Charge Code	16001007
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.64
Max. Negotiated Rate	$6,500.64
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.64

LPS FLEX ARTI SURFACE POLYETHY

Facility

$5,862.10

Hospital Charge Code	270657964
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

LPS FLEX ARTI SURFACE POLYETHY

Facility

$5,862.10

Hospital Charge Code	270657964
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

LPS FLEX FIXED SUR CD 1-2 12MM

Facility

$5,862.10

Hospital Charge Code	270669608
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

LPS FLEX FIXED SUR CD 1-2 12MM

Facility

$5,862.10

Hospital Charge Code	270669608
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

LPS FLEX FIXED SUR CD 1-2 14MM

Facility

$5,862.10

Hospital Charge Code	270657092
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

LPS FLEX FIXED SUR CD 1-2 14MM

Facility

$5,862.10

Hospital Charge Code	270657092
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

LPS-FLEX GSF OPTION FEMORAL

Facility

$12,166.15

Hospital Charge Code	270657848
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$6,083.07
Rate for Payer: Aetna Commercial	$3,649.84
Rate for Payer: Aetna Medicare Advantage	$3,649.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.37
Rate for Payer: Cigna Commercial	$6,083.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,944.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

LPS-FLEX GSF OPTION FEMORAL

Facility

$12,166.15

Hospital Charge Code	270657848
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$2,944.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,944.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$12,166.15

Hospital Charge Code	270662344
Hospital Revenue Code	272
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$1,824.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$12,166.15

Hospital Charge Code	270657034
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$2,944.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,944.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$12,166.15

Hospital Charge Code	270662344
Hospital Revenue Code	272
Min. Negotiated Rate	$1,581.60
Max. Negotiated Rate	$6,083.07
Rate for Payer: Aetna Commercial	$3,649.84
Rate for Payer: Aetna Medicare Advantage	$3,649.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.37
Rate for Payer: Cigna Commercial	$6,083.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.60
Rate for Payer: Oxford Commercial	$6,083.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92
Rate for Payer: UnitedHealthcare Commercial	$6,083.07

LPS-FLEX GSF OPTION FEMORAL, S

Facility

$12,166.15

Hospital Charge Code	270657034
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$6,083.07
Rate for Payer: Aetna Commercial	$3,649.84
Rate for Payer: Aetna Medicare Advantage	$3,649.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.37
Rate for Payer: Cigna Commercial	$6,083.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,944.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

Know your out-of-pocket cost for care.

All Charges