Heights University Hospital

All Charges

Charge

Type

Setting

Price

LSFMC DI RY 2ND & 3RD TMT PT

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270701595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.00
Max. Negotiated Rate	$4,180.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$2,508.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,131.80
Rate for Payer: Cigna Commercial	$4,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00

L/S RATIO***

Facility

$67.00

Hospital Charge Code	3010261
Hospital Revenue Code	301
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

L/S RATIO***

Facility

$67.00

Hospital Charge Code	3010261
Hospital Revenue Code	301
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.10
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$114.00

L/S RATIO, AMNIOTIC FLUID

Facility

$437.00

Service Code	HCPCS 83661
Hospital Charge Code	38473110
Hospital Revenue Code	301
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$65.55
Rate for Payer: Qualcare PPO/HMO/WC	$65.55

L/S RATIO, AMNIOTIC FLUID

Facility

$437.00

Service Code	HCPCS 83661
Hospital Charge Code	38473110
Hospital Revenue Code	301
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.57
Rate for Payer: Cigna Commercial	$21.99
Rate for Payer: Cigna Medicare Advantage	$10.99
Rate for Payer: Clover Medicare Advantage	$20.89
Rate for Payer: EmblemHealth Commercial	$65.97
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.31
Rate for Payer: Wellcare Medicare Advantage	$21.99

LS TIBIAL BEARING 22MM

Facility

$5,625.00

Hospital Charge Code	270678333
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

LS TIBIAL BEARING 22MM

Facility

$5,625.00

Hospital Charge Code	270678333
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

LT PIPE STORZ FITTING THREADED

Facility

$2,920.05

Service Code	HCPCS C1713
Hospital Charge Code	270704143
Hospital Revenue Code	278
Min. Negotiated Rate	$438.01
Max. Negotiated Rate	$1,460.03
Rate for Payer: Aetna Commercial	$876.01
Rate for Payer: Aetna Medicare Advantage	$876.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$584.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$744.61
Rate for Payer: Cigna Commercial	$1,460.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.65
Rate for Payer: Qualcare PPO/HMO/WC	$438.01

LT PIPE STORZ FITTING THREADED

Facility

$2,920.05

Service Code	HCPCS C1713
Hospital Charge Code	270704143
Hospital Revenue Code	278
Min. Negotiated Rate	$438.01
Max. Negotiated Rate	$706.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$584.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.65
Rate for Payer: Qualcare PPO/HMO/WC	$438.01

LTX NANOTEC SPACER 6X22X55MM 1

Facility

$50,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270706118
Hospital Revenue Code	278
Min. Negotiated Rate	$7,631.25
Max. Negotiated Rate	$25,437.50
Rate for Payer: Aetna Commercial	$15,262.50
Rate for Payer: Aetna Medicare Advantage	$15,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,973.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,973.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,973.12
Rate for Payer: Cigna Commercial	$25,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,311.75
Rate for Payer: Qualcare PPO/HMO/WC	$7,631.25

LTX NANOTEC SPACER 6X22X55MM 1

Facility

$50,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270706118
Hospital Revenue Code	278
Min. Negotiated Rate	$7,631.25
Max. Negotiated Rate	$12,311.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,311.75
Rate for Payer: Qualcare PPO/HMO/WC	$7,631.25

LUBRICANT EYE DROPS UD

Facility

$4.00

Service Code	NDC 23050601
Hospital Charge Code	60628083
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

LUBRICANT EYE DROPS UD

Facility

$4.00

Service Code	NDC 23050601
Hospital Charge Code	60628083
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LUBRICANT MIDAS REX

Facility

$31.00

Hospital Charge Code	270335561
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

LUBRICANT MIDAS REX

Facility

$31.00

Hospital Charge Code	270335561
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$15.50

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016C
Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$200.00

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016C
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

LUBRICATI EYE DRPS 15ML

Facility

$73.00

Hospital Charge Code	6003370
Hospital Revenue Code	251
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LUBRICATI EYE DRPS 15ML

Facility

$73.00

Hospital Charge Code	6003370
Hospital Revenue Code	251
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

LUBRIGLIDE COATED GUIDWIRE 3C

Facility

$213.10

Hospital Charge Code	270652682
Hospital Revenue Code	270
Min. Negotiated Rate	$31.96
Max. Negotiated Rate	$31.96
Rate for Payer: Qualcare PPO/HMO/WC	$31.96

LUBRIGLIDE COATED GUIDWIRE 3C

Facility

$213.10

Hospital Charge Code	270652682
Hospital Revenue Code	270
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$106.55
Rate for Payer: Aetna Commercial	$63.93
Rate for Payer: Aetna Medicare Advantage	$63.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.34
Rate for Payer: Cigna Commercial	$106.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.70
Rate for Payer: Oxford Commercial	$106.55
Rate for Payer: Qualcare PPO/HMO/WC	$31.96
Rate for Payer: UnitedHealthcare Commercial	$106.55

LUBRI-GLIDE GUIDEWIRE MOVABLE

Facility

$303.00

Hospital Charge Code	270330754
Hospital Revenue Code	278
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$73.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.33
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LUBRI-GLIDE GUIDEWIRE MOVABLE

Facility

$303.00

Hospital Charge Code	270330754
Hospital Revenue Code	278
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$90.90
Rate for Payer: Aetna Medicare Advantage	$90.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.33
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LUDIMOL/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634386
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LUDIMOL/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634386
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

Know your out-of-pocket cost for care.

All Charges