Heights University Hospital

All Charges

Charge

Type

Setting

Price

LYSOZYME (URINE MURAMIDASE)

Facility

$204.00

Service Code	HCPCS 85549
Hospital Charge Code	3030285
Hospital Revenue Code	305
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

LYSOZYME (URINE MURAMIDASE)

Facility

$204.00

Service Code	HCPCS 85549
Hospital Charge Code	3030285
Hospital Revenue Code	305
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.75
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	$68.70
Rate for Payer: Cigna Commercial	$18.75
Rate for Payer: Cigna Medicare Advantage	$9.38
Rate for Payer: Clover Medicare Advantage	$17.81
Rate for Payer: EmblemHealth Commercial	$56.25
Rate for Payer: Humana Medicare Advantage	$19.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.88
Rate for Payer: Wellcare Medicare Advantage	$18.75

LYTES 1

Facility

$390.00

Service Code	HCPCS 82438
Hospital Charge Code	39708030A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYTES 1

Facility

$390.00

Service Code	HCPCS 82438
Hospital Charge Code	39708030A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Aetna Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.32
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: Cigna Medicare Advantage	$2.50
Rate for Payer: Clover Medicare Advantage	$4.75
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Humana Medicare Advantage	$5.15
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	$5.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.30
Rate for Payer: Wellcare Medicare Advantage	$5.00

LYTES 2

Facility

$390.00

Service Code	HCPCS 84302
Hospital Charge Code	39708030B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.81
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: Cigna Medicare Advantage	$2.43
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
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	$4.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.15
Rate for Payer: Wellcare Medicare Advantage	$4.86

LYTES 2

Facility

$390.00

Service Code	HCPCS 84302
Hospital Charge Code	366884302
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYTES 2

Facility

$390.00

Service Code	HCPCS 84302
Hospital Charge Code	366884302
Hospital Revenue Code	301
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.81
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: Cigna Medicare Advantage	$2.43
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
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	$4.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.15
Rate for Payer: Wellcare Medicare Advantage	$4.86

LYTES 2

Facility

$390.00

Service Code	HCPCS 84302
Hospital Charge Code	39708030B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYTES 24H SODIUM

Facility

$517.00

Service Code	HCPCS 82340
Hospital Charge Code	38479473
Hospital Revenue Code	301
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

LYTES 24H SODIUM

Facility

$517.00

Service Code	HCPCS 82340
Hospital Charge Code	38479473
Hospital Revenue Code	301
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.54
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.09
Rate for Payer: Cigna Commercial	$6.03
Rate for Payer: Cigna Medicare Advantage	$3.02
Rate for Payer: Clover Medicare Advantage	$5.73
Rate for Payer: EmblemHealth Commercial	$18.09
Rate for Payer: Humana Medicare Advantage	$6.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.39
Rate for Payer: Wellcare Medicare Advantage	$6.03

LYTES 3

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39708030C
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.24
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.68
Rate for Payer: Cigna Commercial	$8.10
Rate for Payer: Cigna Medicare Advantage	$4.05
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
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	$8.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.59
Rate for Payer: Wellcare Medicare Advantage	$8.10

LYTES 3

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39708030C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYTES CHLORIDE

Facility

$107.00

Service Code	HCPCS 82436
Hospital Charge Code	38479475
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

LYTES CHLORIDE

Facility

$107.00

Service Code	HCPCS 82436
Hospital Charge Code	38479475
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.07
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.46
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Humana Medicare Advantage	$5.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.09
Rate for Payer: Wellcare Medicare Advantage	$5.75

LYTES POTASIUM

Facility

$119.00

Service Code	HCPCS 84133
Hospital Charge Code	38479474
Hospital Revenue Code	301
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.33
Rate for Payer: Cigna Commercial	$4.73
Rate for Payer: Cigna Medicare Advantage	$2.37
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.01
Rate for Payer: Wellcare Medicare Advantage	$4.73

LYTES POTASIUM

Facility

$119.00

Service Code	HCPCS 84133
Hospital Charge Code	38479474
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

LYTU CHLORIDE URINE

Facility

$390.00

Service Code	HCPCS 82436
Hospital Charge Code	3036012C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.07
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.46
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Humana Medicare Advantage	$5.92
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	$5.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.09
Rate for Payer: Wellcare Medicare Advantage	$5.75

LYTU CHLORIDE URINE

Facility

$390.00

Service Code	HCPCS 82436
Hospital Charge Code	3036012C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYTU POTASSIUM SERUM PLSMA WB

Facility

$390.00

Service Code	HCPCS 84132
Hospital Charge Code	3036012B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.42
Rate for Payer: Aetna Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.44
Rate for Payer: Cigna Commercial	$4.76
Rate for Payer: Cigna Medicare Advantage	$2.38
Rate for Payer: Clover Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$14.28
Rate for Payer: Humana Medicare Advantage	$4.90
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	$4.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.05
Rate for Payer: Wellcare Medicare Advantage	$4.76

LYTU POTASSIUM SERUM PLSMA WB

Facility

$390.00

Service Code	HCPCS 84132
Hospital Charge Code	3036012B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYTU - SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3036012A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.39
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.54
Rate for Payer: Cigna Commercial	$5.06
Rate for Payer: Cigna Medicare Advantage	$2.53
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
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	$5.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.36
Rate for Payer: Wellcare Medicare Advantage	$5.06

LYTU - SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3036012A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

M3 ALIF COVER PLATE ASSEMBLY

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704774
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

M3 ALIF COVER PLATE ASSEMBLY

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704774
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

M3 ALIF SCREW 5.5X20MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704773
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges