Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEPTOSPIRAL ANTIBODIES

Facility

$103.25

Service Code	HCPCS 86720
Hospital Charge Code	3006681
Hospital Revenue Code	302
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.49
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.20
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	$59.36
Rate for Payer: Cigna Commercial	$16.20
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$15.39
Rate for Payer: EmblemHealth Commercial	$48.60
Rate for Payer: Humana Medicare Advantage	$16.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.17
Rate for Payer: Wellcare Medicare Advantage	$16.20

LEPTOSPIRAL ANTIBODIES

Facility

$103.25

Service Code	HCPCS 86720
Hospital Charge Code	3006681
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

LESD BLOOD

Facility

$325.00

Service Code	HCPCS 83655
Hospital Charge Code	38479441
Hospital Revenue Code	301
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.24
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$12.11
Rate for Payer: Cigna Medicare Advantage	$6.05
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.84
Rate for Payer: Wellcare Medicare Advantage	$12.11

LESD BLOOD

Facility

$325.00

Service Code	HCPCS 83655
Hospital Charge Code	38479441
Hospital Revenue Code	301
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

LETROZOLE 2.5 MG TAB

Facility

$82.70

Hospital Charge Code	60629958
Hospital Revenue Code	250
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$12.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.40

LETROZOLE 2.5 MG TAB

Facility

$82.70

Hospital Charge Code	60629958
Hospital Revenue Code	250
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$41.35
Rate for Payer: Aetna Commercial	$24.81
Rate for Payer: Aetna Medicare Advantage	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.09
Rate for Payer: Cigna Commercial	$41.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.75
Rate for Payer: Oxford Commercial	$41.35
Rate for Payer: Qualcare PPO/HMO/WC	$12.40
Rate for Payer: UnitedHealthcare Commercial	$41.35

LETS KIT (LIDO,EPI,TETRA)100ML

Facility

$893.18

Service Code	NDC 51552134501
Hospital Charge Code	606390302
Hospital Revenue Code	250
Min. Negotiated Rate	$116.11
Max. Negotiated Rate	$446.59
Rate for Payer: Aetna Commercial	$267.95
Rate for Payer: Aetna Medicare Advantage	$267.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.76
Rate for Payer: Cigna Commercial	$446.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.11
Rate for Payer: Oxford Commercial	$446.59
Rate for Payer: Qualcare PPO/HMO/WC	$133.98
Rate for Payer: UnitedHealthcare Commercial	$446.59

LETS KIT (LIDO,EPI,TETRA)100ML

Facility

$893.18

Service Code	NDC 51552134501
Hospital Charge Code	606390302
Hospital Revenue Code	250
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$133.98
Rate for Payer: Qualcare PPO/HMO/WC	$133.98

LETTERS, ADBM BARKLEY SYSTEM

Facility

$45.00

Hospital Charge Code	270653924
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

LETTERS, ADBM BARKLEY SYSTEM

Facility

$45.00

Hospital Charge Code	270653924
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

LETTERS ADBM BARKLEY SYSTEM M

Facility

$35.00

Hospital Charge Code	270653926
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

LETTERS ADBM BARKLEY SYSTEM M

Facility

$35.00

Hospital Charge Code	270653926
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$10.50
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$17.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$17.50

LETTERS ADBM BARKLEY SYSTEM R

Facility

$125.00

Hospital Charge Code	270653909
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

LETTERS ADBM BARKLEY SYSTEM R

Facility

$125.00

Hospital Charge Code	270653909
Hospital Revenue Code	272
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

LETZ LOOP WITH SAFE-T

Facility

$75.00

Hospital Charge Code	270658139
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

LETZ LOOP WITH SAFE-T

Facility

$75.00

Hospital Charge Code	270658139
Hospital Revenue Code	270
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

LEUCINE AMINOPEPTIDASE (LAP)

Facility

$154.00

Service Code	HCPCS 83670
Hospital Charge Code	38472452
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

LEUCINE AMINOPEPTIDASE (LAP)

Facility

$154.00

Service Code	HCPCS 83670
Hospital Charge Code	38472452
Hospital Revenue Code	301
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.78
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.94
Rate for Payer: Cigna Commercial	$9.81
Rate for Payer: Cigna Medicare Advantage	$4.91
Rate for Payer: Clover Medicare Advantage	$9.32
Rate for Payer: EmblemHealth Commercial	$29.43
Rate for Payer: Humana Medicare Advantage	$10.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.40
Rate for Payer: Wellcare Medicare Advantage	$9.81

LEUCOVORIN CALCIUM/100MG

Facility

$574.00

Hospital Charge Code	60633276
Hospital Revenue Code	636
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$138.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.91
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

LEUCOVORIN CALCIUM/100MG

Facility

$574.00

Hospital Charge Code	60633276
Hospital Revenue Code	636
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$287.00
Rate for Payer: Aetna Commercial	$172.20
Rate for Payer: Aetna Medicare Advantage	$172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.37
Rate for Payer: Cigna Commercial	$287.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.91
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

LEUCOVORIN CALCIUM 100 MG VIAL

Facility

$160.80

Service Code	HCPCS J0640
Hospital Charge Code	60628530
Hospital Revenue Code	636
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$48.24
Rate for Payer: Aetna Commercial	$48.24
Rate for Payer: Aetna Medicare Advantage	$48.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.00
Rate for Payer: Cigna Commercial	$3.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

LEUCOVORIN CALCIUM 100 MG VIAL

Facility

$160.80

Service Code	HCPCS J0640
Hospital Charge Code	60628530
Hospital Revenue Code	636
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$38.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

LEUCOVORIN CALCIUM/10MG/1

Facility

$42.00

Hospital Charge Code	60633277
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$21.00

LEUCOVORIN CALCIUM/10MG/1

Facility

$42.00

Hospital Charge Code	60633277
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

LEUCOVORIN CALCIUM 25MG TAB

Facility

$91.72

Service Code	NDC 51079058205
Hospital Charge Code	60629049
Hospital Revenue Code	250
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$45.86
Rate for Payer: Aetna Commercial	$27.52
Rate for Payer: Aetna Medicare Advantage	$27.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.39
Rate for Payer: Cigna Commercial	$45.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.92
Rate for Payer: Oxford Commercial	$45.86
Rate for Payer: Qualcare PPO/HMO/WC	$13.76
Rate for Payer: UnitedHealthcare Commercial	$45.86

Know your out-of-pocket cost for care.

All Charges