Heights University Hospital

All Charges

Charge

Type

Setting

Price

LUDIMOL/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634385
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

LUDIMOL/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LUDIOMIL/50MG/TAB

Facility

$6.00

Hospital Charge Code	60633335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LUDIOMIL/50MG/TAB

Facility

$6.00

Hospital Charge Code	60633335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

LUGOL'S 8 ML UD SOLUTION

Facility

$73.30

Service Code	NDC 10481011108
Hospital Charge Code	60629842
Hospital Revenue Code	250
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$10.99
Rate for Payer: Qualcare PPO/HMO/WC	$10.99

LUGOL'S 8 ML UD SOLUTION

Facility

$73.30

Service Code	NDC 10481011108
Hospital Charge Code	60629842
Hospital Revenue Code	250
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$36.65
Rate for Payer: Aetna Commercial	$21.99
Rate for Payer: Aetna Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.69
Rate for Payer: Cigna Commercial	$36.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.53
Rate for Payer: Oxford Commercial	$36.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.99
Rate for Payer: UnitedHealthcare Commercial	$36.65

LUGOL'S SOLUTION

Facility

$9.00

Hospital Charge Code	60634768
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

LUGOL'S SOLUTION

Facility

$9.00

Hospital Charge Code	60634768
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LUMBAR ANCHORS 25MM

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705490
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

LUMBAR ANCHORS 25MM

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705490
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

LUMBAR EPIDURAL INJECTION****

Facility

$330.00

Hospital Charge Code	1001145
Hospital Revenue Code	361
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

LUMBAR EPIDURAL INJECTION****

Facility

$330.00

Hospital Charge Code	1001145
Hospital Revenue Code	361
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
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	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

LUMBAR PLEXUS BLOCK BIL

Facility

$5,939.55

Service Code	HCPCS 6452050
Hospital Charge Code	1650121
Hospital Revenue Code	361
Min. Negotiated Rate	$890.93
Max. Negotiated Rate	$890.93
Rate for Payer: Qualcare PPO/HMO/WC	$890.93

LUMBAR PLEXUS BLOCK BIL

Facility

$5,939.55

Service Code	HCPCS 6452050
Hospital Charge Code	1650121
Hospital Revenue Code	361
Min. Negotiated Rate	$772.14
Max. Negotiated Rate	$2,969.78
Rate for Payer: Aetna Commercial	$1,781.87
Rate for Payer: Aetna Medicare Advantage	$1,781.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,514.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,514.59
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	$1,514.59
Rate for Payer: Cigna Commercial	$2,969.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$772.14
Rate for Payer: Qualcare PPO/HMO/WC	$890.93

LUMBAR PLEXUS BLOCK UNI

Facility

$3,959.70

Service Code	HCPCS 64520
Hospital Charge Code	1650120
Hospital Revenue Code	361
Min. Negotiated Rate	$593.96
Max. Negotiated Rate	$593.96
Rate for Payer: Qualcare PPO/HMO/WC	$593.96

LUMBAR PLEXUS BLOCK UNI

Facility

$3,959.70

Service Code	HCPCS 64520
Hospital Charge Code	1650120
Hospital Revenue Code	361
Min. Negotiated Rate	$514.76
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,187.91
Rate for Payer: Aetna Medicare Advantage	$1,187.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,009.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,009.72
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	$1,009.72
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$593.96
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

LUMBAR PUNCTURE

Facility

$1,695.00

Service Code	HCPCS 62270
Hospital Charge Code	3409001
Hospital Revenue Code	761
Min. Negotiated Rate	$220.35
Max. Negotiated Rate	$1,680.99
Rate for Payer: Aetna Commercial	$508.50
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.35
Rate for Payer: Oxford Commercial	$847.50
Rate for Payer: Qualcare PPO/HMO/WC	$254.25
Rate for Payer: UnitedHealthcare Commercial	$847.50

LUMBAR PUNCTURE

Facility

$1,695.00

Service Code	HCPCS 62270
Hospital Charge Code	3409001
Hospital Revenue Code	761
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$254.25
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	1001135
Hospital Revenue Code	361
Min. Negotiated Rate	$477.86
Max. Negotiated Rate	$477.86
Rate for Payer: Qualcare PPO/HMO/WC	$477.86

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	93500003
Hospital Revenue Code	761
Min. Negotiated Rate	$477.86
Max. Negotiated Rate	$477.86
Rate for Payer: Qualcare PPO/HMO/WC	$477.86

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	1001135
Hospital Revenue Code	361
Min. Negotiated Rate	$414.15
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$955.73
Rate for Payer: Aetna Medicare Advantage	$955.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$812.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$812.37
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	$812.37
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.15
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$477.86
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	93500003
Hospital Revenue Code	761
Min. Negotiated Rate	$414.15
Max. Negotiated Rate	$1,680.99
Rate for Payer: Aetna Commercial	$955.73
Rate for Payer: Aetna Medicare Advantage	$955.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$812.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$812.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$812.37
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.15
Rate for Payer: Oxford Commercial	$1,592.88
Rate for Payer: Qualcare PPO/HMO/WC	$477.86
Rate for Payer: UnitedHealthcare Commercial	$1,592.88

LUMBAR PUNCTURE INFANT

Facility

$42.70

Hospital Charge Code	270665029
Hospital Revenue Code	270
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$6.41
Rate for Payer: Qualcare PPO/HMO/WC	$6.41

LUMBAR PUNCTURE INFANT

Facility

$42.70

Hospital Charge Code	270665029
Hospital Revenue Code	270
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$21.35
Rate for Payer: Aetna Commercial	$12.81
Rate for Payer: Aetna Medicare Advantage	$12.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.89
Rate for Payer: Cigna Commercial	$21.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.55
Rate for Payer: Oxford Commercial	$21.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.41
Rate for Payer: UnitedHealthcare Commercial	$21.35

LUMBAR PUNTURE DX W FLUORO

Facility

$3,999.00

Service Code	HCPCS 62328
Hospital Charge Code	5100854
Hospital Revenue Code	361
Min. Negotiated Rate	$519.87
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,199.70
Rate for Payer: Aetna Medicare Advantage	$1,199.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,019.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,019.75
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	$1,019.75
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$519.87
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$599.85
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

Know your out-of-pocket cost for care.

All Charges