Heights University Hospital

All Charges

Charge

Type

Setting

Price

LYME ANTIBODIES, IgM, QUANT

Facility

$429.00

Service Code	HCPCS 86618
Hospital Charge Code	38476189
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME ANTIBODIES, QUANT

Facility

$542.00

Service Code	HCPCS 86618
Hospital Charge Code	38476186
Hospital Revenue Code	302
Min. Negotiated Rate	$81.30
Max. Negotiated Rate	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$81.30

LYME ANTIBODIES, QUANT

Facility

$542.00

Service Code	HCPCS 86618
Hospital Charge Code	38476186
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME ANTIBODY, CSF

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3032315
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME ANTIBODY, CSF

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3032315
Hospital Revenue Code	302
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

LYME CONFIRMATION TEST

Facility

$190.00

Service Code	HCPCS 86617
Hospital Charge Code	38476266
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	$24.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
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 CONFIRMATION TEST

Facility

$190.00

Service Code	HCPCS 86617
Hospital Charge Code	38476266
Hospital Revenue Code	302
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

LYME DISEASE AB W/RFX

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3032352
Hospital Revenue Code	300
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

LYME DISEASE AB W/RFX

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3032352
Hospital Revenue Code	300
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME DISEASE ANTIBODY

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3006699
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME DISEASE ANTIBODY

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3006699
Hospital Revenue Code	302
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

LYME DISEASE ANTIBODY, IGM

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3032316
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME DISEASE ANTIBODY, IGM

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3032316
Hospital Revenue Code	302
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

LYME DISEASE(B.SPP)DNA,SF

Facility

$825.84

Service Code	HCPCS 87801
Hospital Charge Code	39900307
Hospital Revenue Code	306
Min. Negotiated Rate	$123.88
Max. Negotiated Rate	$123.88
Rate for Payer: Qualcare PPO/HMO/WC	$123.88

LYME DISEASE(B.SPP)DNA,SF

Facility

$825.84

Service Code	HCPCS 87801
Hospital Charge Code	39900307
Hospital Revenue Code	306
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$257.21
Rate for Payer: Aetna Commercial	$227.45
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$257.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$257.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$257.21
Rate for Payer: Cigna Commercial	$70.20
Rate for Payer: Cigna Medicare Advantage	$35.10
Rate for Payer: Clover Medicare Advantage	$66.69
Rate for Payer: EmblemHealth Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$72.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.88
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$74.41
Rate for Payer: Wellcare Medicare Advantage	$70.20

LYME DISEASE DNA CSF

Facility

$1,132.80

Service Code	HCPCS 87801
Hospital Charge Code	397041356
Hospital Revenue Code	306
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$257.21
Rate for Payer: Aetna Commercial	$227.45
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$257.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$257.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$257.21
Rate for Payer: Cigna Commercial	$70.20
Rate for Payer: Cigna Medicare Advantage	$35.10
Rate for Payer: Clover Medicare Advantage	$66.69
Rate for Payer: EmblemHealth Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$72.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.92
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$74.41
Rate for Payer: Wellcare Medicare Advantage	$70.20

LYME DISEASE DNA CSF

Facility

$1,132.80

Service Code	HCPCS 87801
Hospital Charge Code	397041356
Hospital Revenue Code	306
Min. Negotiated Rate	$169.92
Max. Negotiated Rate	$169.92
Rate for Payer: Qualcare PPO/HMO/WC	$169.92

Lyme Disease, Total Antibody T

Facility

$117.05

Service Code	HCPCS 86618
Hospital Charge Code	39888013
Hospital Revenue Code	302
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$17.56
Rate for Payer: Qualcare PPO/HMO/WC	$17.56

Lyme Disease, Total Antibody T

Facility

$117.05

Service Code	HCPCS 86618
Hospital Charge Code	39888013
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.56
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME DISEASE WITH REFLEX TO WE

Facility

$667.59

Service Code	HCPCS 86618
Hospital Charge Code	39900370
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME DISEASE WITH REFLEX TO WE

Facility

$667.59

Service Code	HCPCS 86618
Hospital Charge Code	39900370
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LYME IMMUNOBLOT

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3006830
Hospital Revenue Code	302
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

LYME IMMUNOBLOT

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3006830
Hospital Revenue Code	302
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

LYME PCR - B. BURGDORFERI

Facility

$614.45

Service Code	HCPCS 87476
Hospital Charge Code	3009785
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.17
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

LYME PCR - B. BURGDORFERI

Facility

$614.45

Service Code	HCPCS 87476
Hospital Charge Code	3009785
Hospital Revenue Code	306
Min. Negotiated Rate	$92.17
Max. Negotiated Rate	$92.17
Rate for Payer: Qualcare PPO/HMO/WC	$92.17

Know your out-of-pocket cost for care.

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