Heights University Hospital

All Charges

Charge

Type

Setting

Price

LACOSAMIDE 50 MG TAB

Facility

$58.89

Service Code	NDC 131247735
Hospital Charge Code	6063943363
Hospital Revenue Code	250
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$8.83
Rate for Payer: Qualcare PPO/HMO/WC	$8.83

LACOSAMIDE 50 MG TAB

Facility

$58.89

Service Code	NDC 131247735
Hospital Charge Code	6063943363
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$29.45
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$17.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.02
Rate for Payer: Cigna Commercial	$29.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.66
Rate for Payer: Oxford Commercial	$29.45
Rate for Payer: Qualcare PPO/HMO/WC	$8.83
Rate for Payer: UnitedHealthcare Commercial	$29.45

Lacosamide level

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39708018
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

Lacosamide level

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39708018
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LAC REP PALATE OVER 2 CM

Facility

$18,789.72

Service Code	HCPCS 42182
Hospital Charge Code	5780210
Hospital Revenue Code	450
Min. Negotiated Rate	$2,818.46
Max. Negotiated Rate	$2,818.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,818.46

LAC REP PALATE OVER 2 CM

Facility

$18,789.72

Service Code	HCPCS 42182
Hospital Charge Code	5780210
Hospital Revenue Code	450
Min. Negotiated Rate	$155.85
Max. Negotiated Rate	$14,097.46
Rate for Payer: Aetna Commercial	$5,636.92
Rate for Payer: Aetna Medicare Advantage	$5,636.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,791.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,791.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,791.38
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,442.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,818.46

LAC REP PALATE UP TO 2 CM

Facility

$1,453.00

Service Code	HCPCS 42180
Hospital Charge Code	5780205
Hospital Revenue Code	450
Min. Negotiated Rate	$111.32
Max. Negotiated Rate	$1,284.36
Rate for Payer: Aetna Commercial	$435.90
Rate for Payer: Aetna Medicare Advantage	$435.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.51
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.89
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

LAC REP PALATE UP TO 2 CM

Facility

$1,453.00

Service Code	HCPCS 42180
Hospital Charge Code	5780205
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

LACRILUBE/3.5GM

Facility

$76.31

Service Code	NDC 23031204
Hospital Charge Code	60634565
Hospital Revenue Code	250
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$11.45
Rate for Payer: Qualcare PPO/HMO/WC	$11.45

LACRILUBE/3.5GM

Facility

$76.31

Service Code	NDC 23031204
Hospital Charge Code	60634565
Hospital Revenue Code	250
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$38.16
Rate for Payer: Aetna Commercial	$22.89
Rate for Payer: Aetna Medicare Advantage	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$38.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.92
Rate for Payer: Oxford Commercial	$38.16
Rate for Payer: Qualcare PPO/HMO/WC	$11.45
Rate for Payer: UnitedHealthcare Commercial	$38.16

LACRILUBE DROPPERETTES

Facility

$4.50

Hospital Charge Code	6014039
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

LACRILUBE DROPPERETTES

Facility

$4.50

Hospital Charge Code	6014039
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

LACTASE TAB 3300U

Facility

$1.95

Hospital Charge Code	60628631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

LACTASE TAB 3300U

Facility

$1.95

Hospital Charge Code	60628631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

LACTATE,CSF

Facility

$390.00

Service Code	HCPCS 83605
Hospital Charge Code	39900101
Hospital Revenue Code	301
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.49
Rate for Payer: Aetna Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.39
Rate for Payer: Cigna Commercial	$11.57
Rate for Payer: Cigna Medicare Advantage	$5.79
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.26
Rate for Payer: Wellcare Medicare Advantage	$11.57

LACTATE,CSF

Facility

$390.00

Service Code	HCPCS 83605
Hospital Charge Code	39900101
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LACTATE DEHYDROGENASE (LD/LDH)

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38472437
Hospital Revenue Code	301
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.30

LACTATE DEHYDROGENASE (LD/LDH)

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38472437
Hospital Revenue Code	301
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.57
Rate for Payer: Aetna Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.13
Rate for Payer: Cigna Commercial	$6.04
Rate for Payer: Cigna Medicare Advantage	$3.02
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.40
Rate for Payer: Wellcare Medicare Advantage	$6.04

LACTATED RINGERS 1000cc

Facility

$5.72

Hospital Charge Code	270650053
Hospital Revenue Code	258
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LACTATED RINGERS 1000cc

Facility

$5.72

Hospital Charge Code	270650053
Hospital Revenue Code	258
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$2.86
Rate for Payer: Aetna Commercial	$1.72
Rate for Payer: Aetna Medicare Advantage	$1.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.46
Rate for Payer: Cigna Commercial	$2.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$2.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$2.86

LACTATED RINGER'S 1000 ML SOL

Facility

$16.48

Service Code	NDC 338011704
Hospital Charge Code	60627910
Hospital Revenue Code	258
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$8.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$8.24

LACTATED RINGER'S 1000 ML SOL

Facility

$16.48

Service Code	NDC 338011704
Hospital Charge Code	60627910
Hospital Revenue Code	258
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

LACTATED RINGERS 500ml

Facility

$5.60

Hospital Charge Code	270649837
Hospital Revenue Code	258
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.43
Rate for Payer: Cigna Commercial	$2.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$2.80

LACTATED RINGERS 500ml

Facility

$5.60

Hospital Charge Code	270649837
Hospital Revenue Code	258
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

LACTIC ACID

Facility

$191.00

Service Code	HCPCS 83605
Hospital Charge Code	38472443
Hospital Revenue Code	301
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

Know your out-of-pocket cost for care.

All Charges