Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

LACTIC ACID, ALL SOURCES

Facility

$636.05

Service Code	HCPCS 83605
Hospital Charge Code	3008380
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	$82.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.41
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

LACTIC ACID, ALL SOURCES

Facility

$636.05

Service Code	HCPCS 83605
Hospital Charge Code	3008380
Hospital Revenue Code	301
Min. Negotiated Rate	$95.41
Max. Negotiated Rate	$95.41
Rate for Payer: Qualcare PPO/HMO/WC	$95.41

LACTIC ACID CSF

Facility

$113.65

Service Code	HCPCS 83605
Hospital Charge Code	3000708
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	$14.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
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

LACTIC ACID CSF

Facility

$113.65

Service Code	HCPCS 83605
Hospital Charge Code	3000708
Hospital Revenue Code	301
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

LACTIC ACID DEHYDRGNSE LDH RPT

Facility

$419.12

Service Code	HCPCS 8361591
Hospital Charge Code	3001757R
Hospital Revenue Code	301
Min. Negotiated Rate	$62.87
Max. Negotiated Rate	$62.87
Rate for Payer: Qualcare PPO/HMO/WC	$62.87

LACTIC ACID DEHYDRGNSE LDH RPT

Facility

$419.12

Service Code	HCPCS 8361591
Hospital Charge Code	3001757R
Hospital Revenue Code	301
Min. Negotiated Rate	$54.49
Max. Negotiated Rate	$209.56
Rate for Payer: Aetna Commercial	$125.74
Rate for Payer: Aetna Medicare Advantage	$125.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.88
Rate for Payer: Cigna Commercial	$209.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.87
Rate for Payer: UnitedHealthcare Commercial	$114.00

LACTIC ACID DEHYDROGENASE LDH

Facility

$717.44

Service Code	HCPCS 83615
Hospital Charge Code	3001757
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	$93.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.62
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

LACTIC ACID DEHYDROGENASE LDH

Facility

$717.44

Service Code	HCPCS 83615
Hospital Charge Code	3001757
Hospital Revenue Code	301
Min. Negotiated Rate	$107.62
Max. Negotiated Rate	$107.62
Rate for Payer: Qualcare PPO/HMO/WC	$107.62

LACTIC ACID DEHY - LDH PANEL**

Facility

$6.00

Service Code	HCPCS 83615
Hospital Charge Code	3001757P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LACTIC ACID DEHY - LDH PANEL**

Facility

$6.00

Service Code	HCPCS 83615
Hospital Charge Code	3001757P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.78
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	$0.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
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

LACTOBACILLUS ACID CAP

Facility

$3.20

Hospital Charge Code	6027122
Hospital Revenue Code	251
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

LACTOBACILLUS ACID CAP

Facility

$3.20

Hospital Charge Code	6027122
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

LACTOBACILLUS ACIDPH CAP 500MG

Facility

$4.00

Service Code	NDC 904660861
Hospital Charge Code	60628158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LACTOBACILLUS ACIDPH CAP 500MG

Facility

$4.00

Service Code	NDC 904660861
Hospital Charge Code	60628158
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

LACTOFERRIN QNT STOOL

Facility

$390.00

Service Code	HCPCS 83631
Hospital Charge Code	38479742
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LACTOFERRIN QNT STOOL

Facility

$390.00

Service Code	HCPCS 83631
Hospital Charge Code	38479742
Hospital Revenue Code	306
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$63.60
Rate for Payer: Aetna Medicare Advantage	$19.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.92
Rate for Payer: Cigna Commercial	$19.63
Rate for Payer: Cigna Medicare Advantage	$9.81
Rate for Payer: Clover Medicare Advantage	$18.65
Rate for Payer: EmblemHealth Commercial	$58.89
Rate for Payer: Humana Medicare Advantage	$20.22
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	$19.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.81
Rate for Payer: Wellcare Medicare Advantage	$19.63

LACTOLOSE LQ 20GM/30ML

Facility

$163.20

Hospital Charge Code	6009765
Hospital Revenue Code	251
Min. Negotiated Rate	$21.22
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna Commercial	$48.96
Rate for Payer: Aetna Medicare Advantage	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$81.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.22
Rate for Payer: Oxford Commercial	$81.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.48
Rate for Payer: UnitedHealthcare Commercial	$81.60

LACTOLOSE LQ 20GM/30ML

Facility

$10.90

Hospital Charge Code	6009757
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

LACTOLOSE LQ 20GM/30ML

Facility

$10.90

Hospital Charge Code	6009757
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

LACTOLOSE LQ 20GM/30ML

Facility

$163.20

Hospital Charge Code	6009765
Hospital Revenue Code	251
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$24.48
Rate for Payer: Qualcare PPO/HMO/WC	$24.48

LACTOSE TOLERANCE (BLOOD)***

Facility

$10.00

Service Code	HCPCS 82952
Hospital Charge Code	3004264B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

LACTOSE TOLERANCE (BLOOD)***

Facility

$10.00

Service Code	HCPCS 82952
Hospital Charge Code	3004264B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

LACTOSE TOLERANCE (BLOOD)***

Facility

$10.00

Service Code	HCPCS 82952
Hospital Charge Code	3007564C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

LACTOSE TOLERANCE (BLOOD)***

Facility

$10.00

Service Code	HCPCS 82952
Hospital Charge Code	3007564B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

Know your out-of-pocket cost for care.

All Charges