Heights University Hospital

All Charges

Charge

Type

Setting

Price

LUMBAR PUNTURE DX W FLUORO

Facility

$3,999.00

Service Code	HCPCS 62328
Hospital Charge Code	5100854
Hospital Revenue Code	361
Min. Negotiated Rate	$599.85
Max. Negotiated Rate	$599.85
Rate for Payer: Qualcare PPO/HMO/WC	$599.85

LUMBAR SPINE 2-3 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72100
Hospital Charge Code	94061065
Hospital Revenue Code	320
Min. Negotiated Rate	$41.14
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

LUMBAR SPINE 2-3 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72100
Hospital Charge Code	94061065
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

LUMBAR SPINE COMPLETE

Facility

$701.00

Service Code	HCPCS 72114
Hospital Charge Code	94061069
Hospital Revenue Code	320
Min. Negotiated Rate	$105.15
Max. Negotiated Rate	$105.15
Rate for Payer: Qualcare PPO/HMO/WC	$105.15

LUMBAR SPINE COMPLETE

Facility

$701.00

Service Code	HCPCS 72114
Hospital Charge Code	94061069
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$210.30
Rate for Payer: Aetna Medicare Advantage	$210.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.75
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

LUMBAR SPINE FUSION

Facility

$17,295.60

Service Code	HCPCS 22558
Hospital Charge Code	16000542
Hospital Revenue Code	360
Min. Negotiated Rate	$2,594.34
Max. Negotiated Rate	$2,594.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,594.34

LUMBAR SPINE FUSION

Facility

$17,295.60

Service Code	HCPCS 22558
Hospital Charge Code	16000542
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$64,616.81
Rate for Payer: Aetna Commercial	$5,188.68
Rate for Payer: Aetna Medicare Advantage	$5,188.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,410.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,410.38
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	$4,410.38
Rate for Payer: Cigna Commercial	$64,616.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,248.43
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,594.34
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

LUMBAR SPINE FUSION COMBINED

Facility

$108,286.15

Service Code	HCPCS 22633
Hospital Charge Code	16000441
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$64,616.81
Rate for Payer: Aetna Commercial	$32,485.85
Rate for Payer: Aetna Medicare Advantage	$32,485.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,612.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,612.97
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	$27,612.97
Rate for Payer: Cigna Commercial	$64,616.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,077.20
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,242.92
Rate for Payer: UnitedHealthcare Commercial	$11,456.00

LUMBAR SPINE FUSION COMBINED

Facility

$108,286.15

Service Code	HCPCS 22633
Hospital Charge Code	16000441
Hospital Revenue Code	360
Min. Negotiated Rate	$16,242.92
Max. Negotiated Rate	$16,242.92
Rate for Payer: Qualcare PPO/HMO/WC	$16,242.92

LUMBAR SPINE FUSION POSTEOR

Facility

$25,747.95

Service Code	HCPCS 22630
Hospital Charge Code	16000543
Hospital Revenue Code	360
Min. Negotiated Rate	$3,862.19
Max. Negotiated Rate	$3,862.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,862.19

LUMBAR SPINE FUSION POSTEOR

Facility

$25,747.95

Service Code	HCPCS 22630
Hospital Charge Code	16000543
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$64,616.81
Rate for Payer: Aetna Commercial	$7,724.39
Rate for Payer: Aetna Medicare Advantage	$7,724.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,565.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,565.73
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	$6,565.73
Rate for Payer: Cigna Commercial	$64,616.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,347.23
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,862.19
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

LUMBOSACRAL SPINE - COMP

Facility

$5,100.00

Service Code	HCPCS 72110
Hospital Charge Code	94061067
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

LUMBOSACRAL SPINE - COMP

Facility

$5,100.00

Service Code	HCPCS 72110
Hospital Charge Code	94061067
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

LUMB SYMP PARAVERT INJ (ANES)

Facility

$3,107.20

Service Code	HCPCS 64520
Hospital Charge Code	84506045
Hospital Revenue Code	361
Min. Negotiated Rate	$403.94
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$932.16
Rate for Payer: Aetna Medicare Advantage	$932.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$792.34
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	$792.34
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.94
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$466.08
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

LUMB SYMP PARAVERT INJ (ANES)

Facility

$3,107.20

Service Code	HCPCS 64520
Hospital Charge Code	84506045
Hospital Revenue Code	361
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

LUNA GRAFT INJECTOR

Facility

$5,104.00

Hospital Charge Code	270697375
Hospital Revenue Code	272
Min. Negotiated Rate	$765.60
Max. Negotiated Rate	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$765.60

LUNA GRAFT INJECTOR

Facility

$5,104.00

Hospital Charge Code	270697375
Hospital Revenue Code	272
Min. Negotiated Rate	$663.52
Max. Negotiated Rate	$2,552.00
Rate for Payer: Aetna Commercial	$1,531.20
Rate for Payer: Aetna Medicare Advantage	$1,531.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,301.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,301.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,301.52
Rate for Payer: Cigna Commercial	$2,552.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.52
Rate for Payer: Oxford Commercial	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.60
Rate for Payer: UnitedHealthcare Commercial	$2,552.00

LUNA XD IMPLANT 12D 12MM

Facility

$53,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270697374
Hospital Revenue Code	278
Min. Negotiated Rate	$8,040.00
Max. Negotiated Rate	$12,971.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,971.20
Rate for Payer: Qualcare PPO/HMO/WC	$8,040.00

LUNA XD IMPLANT 12D 12MM

Facility

$53,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270697374
Hospital Revenue Code	278
Min. Negotiated Rate	$8,040.00
Max. Negotiated Rate	$26,800.00
Rate for Payer: Aetna Commercial	$16,080.00
Rate for Payer: Aetna Medicare Advantage	$16,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,668.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,668.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,668.00
Rate for Payer: Cigna Commercial	$26,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,971.20
Rate for Payer: Qualcare PPO/HMO/WC	$8,040.00

LUNDERQIST EXTRA STIFF WIRE

Facility

$1,506.25

Hospital Charge Code	270658322
Hospital Revenue Code	272
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$225.94
Rate for Payer: Qualcare PPO/HMO/WC	$225.94

LUNDERQIST EXTRA STIFF WIRE

Facility

$1,506.25

Hospital Charge Code	270658322
Hospital Revenue Code	272
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$753.12
Rate for Payer: Aetna Commercial	$451.88
Rate for Payer: Aetna Medicare Advantage	$451.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.09
Rate for Payer: Cigna Commercial	$753.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.81
Rate for Payer: Oxford Commercial	$753.12
Rate for Payer: Qualcare PPO/HMO/WC	$225.94
Rate for Payer: UnitedHealthcare Commercial	$753.12

LUNG MATURITY PROFILE II***

Facility

$83.00

Service Code	HCPCS 83661
Hospital Charge Code	3007598
Hospital Revenue Code	301
Min. Negotiated Rate	$10.79
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	$10.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
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

LUNG MATURITY PROFILE II***

Facility

$83.00

Service Code	HCPCS 83661
Hospital Charge Code	3007598
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

LUNG PERF & VENT SCAN

Facility

$12,000.00

Service Code	HCPCS 78582
Hospital Charge Code	4500928
Hospital Revenue Code	341
Min. Negotiated Rate	$268.18
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

LUNG PERF & VENT SCAN

Facility

$12,000.00

Service Code	HCPCS 78582
Hospital Charge Code	4500928
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

Know your out-of-pocket cost for care.

All Charges