Heights University Hospital

All Charges

Charge

Type

Setting

Price

LURIDE SUGAR FREE/0.125MG

Facility

$49.00

Hospital Charge Code	60633339
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

LURIDE SUGAR FREE/0.125MG

Facility

$49.00

Hospital Charge Code	60633339
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

LUTEINIZING HORMONE (LH)

Facility

$633.00

Service Code	HCPCS 83002
Hospital Charge Code	38472467
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.86
Rate for Payer: Cigna Commercial	$18.52
Rate for Payer: Cigna Medicare Advantage	$9.26
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.63
Rate for Payer: Wellcare Medicare Advantage	$18.52

LUTEINIZING HORMONE (LH)

Facility

$633.00

Service Code	HCPCS 83002
Hospital Charge Code	38472467
Hospital Revenue Code	301
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

LUTEINIZING HORMONE, LH

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	3006319
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.86
Rate for Payer: Cigna Commercial	$18.52
Rate for Payer: Cigna Medicare Advantage	$9.26
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.63
Rate for Payer: Wellcare Medicare Advantage	$18.52

LUTEINIZING HORMONE, LH

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	3006319
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

LUVOX 100MG UD

Facility

$7.00

Hospital Charge Code	60635095
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LUVOX 100MG UD

Facility

$7.00

Hospital Charge Code	60635095
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

LUVOX 50MG UD

Facility

$7.00

Hospital Charge Code	60635094
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

LUVOX 50MG UD

Facility

$7.00

Hospital Charge Code	60635094
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

L VENTRIC PACING LEAD ADD ON

Facility

$27,941.00

Service Code	HCPCS 33225
Hospital Charge Code	411033225
Hospital Revenue Code	481
Min. Negotiated Rate	$4,191.15
Max. Negotiated Rate	$4,191.15
Rate for Payer: Qualcare PPO/HMO/WC	$4,191.15

L VENTRIC PACING LEAD ADD ON

Facility

$27,941.00

Service Code	HCPCS 33225
Hospital Charge Code	411033225
Hospital Revenue Code	481
Min. Negotiated Rate	$425.40
Max. Negotiated Rate	$11,456.00
Rate for Payer: Aetna Commercial	$8,382.30
Rate for Payer: Aetna Medicare Advantage	$8,382.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,124.95
Rate for Payer: Cigna Commercial	$425.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,632.33
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,191.15
Rate for Payer: UnitedHealthcare Commercial	$11,456.00

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	74110020
Hospital Revenue Code	481
Min. Negotiated Rate	$159.23
Max. Negotiated Rate	$159.23
Rate for Payer: Qualcare PPO/HMO/WC	$159.23

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	74110020
Hospital Revenue Code	481
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$4,350.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Aetna Commercial	$318.46
Rate for Payer: Aetna Medicare Advantage	$318.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.70
Rate for Payer: Cigna Commercial	$25.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.23
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	5100185
Hospital Revenue Code	481
Min. Negotiated Rate	$159.23
Max. Negotiated Rate	$159.23
Rate for Payer: Qualcare PPO/HMO/WC	$159.23

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	5100185
Hospital Revenue Code	481
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$318.46
Rate for Payer: Aetna Medicare Advantage	$318.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.70
Rate for Payer: Cigna Commercial	$25.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.23
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

LYME AB IGG, IGM IFA CSF I

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

LYME AB IGG, IGM IFA CSF I

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYME AB IGG, IGM IFA CSF II

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYME AB IGG, IGM IFA CSF II

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

LYME AB WESTERN BLOT IGG

Facility

$205.65

Service Code	HCPCS 86617
Hospital Charge Code	3006831A
Hospital Revenue Code	302
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

LYME AB WESTERN BLOT IGG

Facility

$205.65

Service Code	HCPCS 86617
Hospital Charge Code	3006831A
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.19
Rate for Payer: Aetna Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.76
Rate for Payer: Cigna Commercial	$15.49
Rate for Payer: Cigna Medicare Advantage	$7.75
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.42
Rate for Payer: Wellcare Medicare Advantage	$15.49

LYME AB WESTERN BLOT IGM

Facility

$205.65

Service Code	HCPCS 86617
Hospital Charge Code	3006831B
Hospital Revenue Code	302
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

LYME AB WESTERN BLOT IGM

Facility

$205.65

Service Code	HCPCS 86617
Hospital Charge Code	3006831B
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.19
Rate for Payer: Aetna Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.76
Rate for Payer: Cigna Commercial	$15.49
Rate for Payer: Cigna Medicare Advantage	$7.75
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.42
Rate for Payer: Wellcare Medicare Advantage	$15.49

LYME ANTIBODIES, IgM, QUANT

Facility

$429.00

Service Code	HCPCS 86618
Hospital Charge Code	38476189
Hospital Revenue Code	302
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$64.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.35

Know your out-of-pocket cost for care.

All Charges