Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEUCOVORIN CALCIUM 25MG TAB

Facility

$91.72

Service Code	NDC 51079058205
Hospital Charge Code	60629049
Hospital Revenue Code	250
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$13.76
Rate for Payer: Qualcare PPO/HMO/WC	$13.76

LEUCOVORIN CALCIUM/350MG

Facility

$152.36

Service Code	HCPCS J0640
Hospital Charge Code	60633279
Hospital Revenue Code	636
Min. Negotiated Rate	$22.85
Max. Negotiated Rate	$36.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

LEUCOVORIN CALCIUM/350MG

Facility

$152.36

Service Code	HCPCS J0640
Hospital Charge Code	60633279
Hospital Revenue Code	636
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$45.71
Rate for Payer: Aetna Commercial	$45.71
Rate for Payer: Aetna Medicare Advantage	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.85
Rate for Payer: Cigna Commercial	$3.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

LEUCOVORIN CALCIUM/50MG

Facility

$52.26

Service Code	HCPCS J0640
Hospital Charge Code	60633275
Hospital Revenue Code	636
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$15.68
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$15.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.33
Rate for Payer: Cigna Commercial	$3.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.84

LEUCOVORIN CALCIUM/50MG

Facility

$52.26

Service Code	HCPCS J0640
Hospital Charge Code	60633275
Hospital Revenue Code	636
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.84

LEUCOVORIN CALCIUM/5MG

Facility

$7.00

Hospital Charge Code	60633280
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
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	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LEUCOVORIN CALCIUM/5MG

Facility

$7.00

Hospital Charge Code	60633280
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LEUCOVORIN CALCIUM/5MG

Facility

$18.00

Hospital Charge Code	60633278
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

LEUCOVORIN CALCIUM/5MG

Facility

$18.00

Hospital Charge Code	60633278
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

LEUCOVORIN CALCIUM 5 MG TAB

Facility

$21.78

Service Code	NDC 51079058106
Hospital Charge Code	6008668
Hospital Revenue Code	251
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$6.53
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.83
Rate for Payer: Oxford Commercial	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$10.89

LEUCOVORIN CALCIUM 5 MG TAB

Facility

$21.78

Service Code	NDC 51079058106
Hospital Charge Code	6008668
Hospital Revenue Code	251
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

LEUCOVORIN CAL INJ 50MG

Facility

$26.90

Hospital Charge Code	6003222
Hospital Revenue Code	251
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

LEUCOVORIN CAL INJ 50MG

Facility

$26.90

Hospital Charge Code	6003222
Hospital Revenue Code	251
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$8.07
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$13.45

LEUCOVORIN TAB 25MG

Facility

$85.15

Hospital Charge Code	60628999
Hospital Revenue Code	250
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$42.58
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$25.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.71
Rate for Payer: Cigna Commercial	$42.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.07
Rate for Payer: Oxford Commercial	$42.58
Rate for Payer: Qualcare PPO/HMO/WC	$12.77
Rate for Payer: UnitedHealthcare Commercial	$42.58

LEUCOVORIN TAB 25MG

Facility

$85.15

Hospital Charge Code	60628999
Hospital Revenue Code	250
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: Qualcare PPO/HMO/WC	$12.77

LEUKEMIA LYMPH EVALUATION

Facility

$144.09

Service Code	HCPCS 88180
Hospital Charge Code	3004398
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.23
Rate for Payer: Aetna Medicare Advantage	$43.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.74
Rate for Payer: Cigna Commercial	$72.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.61
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEUKEMIA LYMPH EVALUATION

Facility

$144.09

Service Code	HCPCS 88180
Hospital Charge Code	3004398
Hospital Revenue Code	301
Min. Negotiated Rate	$21.61
Max. Negotiated Rate	$21.61
Rate for Payer: Qualcare PPO/HMO/WC	$21.61

LEUKEMIA LYMPH EVALUATION*****

Facility

$144.09

Service Code	HCPCS 88180
Hospital Charge Code	3006750
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.23
Rate for Payer: Aetna Medicare Advantage	$43.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.74
Rate for Payer: Cigna Commercial	$72.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.61
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEUKEMIA LYMPH EVALUATION*****

Facility

$144.09

Service Code	HCPCS 88180
Hospital Charge Code	3006750
Hospital Revenue Code	301
Min. Negotiated Rate	$21.61
Max. Negotiated Rate	$21.61
Rate for Payer: Qualcare PPO/HMO/WC	$21.61

LEUKEMIA/LYMPHOMA PANEL

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38472439
Hospital Revenue Code	311
Min. Negotiated Rate	$51.09
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$117.90
Rate for Payer: Aetna Medicare Advantage	$117.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.22
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$85.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEUKEMIA/LYMPHOMA PANEL

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38472439
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

LEUKERAN/2MG/TAB

Facility

$7.00

Hospital Charge Code	60633281
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LEUKERAN/2MG/TAB

Facility

$7.00

Hospital Charge Code	60633281
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

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$168.00

Service Code	HCPCS 85540
Hospital Charge Code	38473024
Hospital Revenue Code	305
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.86
Rate for Payer: Aetna Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.51
Rate for Payer: Cigna Commercial	$8.60
Rate for Payer: Cigna Medicare Advantage	$4.30
Rate for Payer: Clover Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$25.80
Rate for Payer: Humana Medicare Advantage	$8.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.12
Rate for Payer: Wellcare Medicare Advantage	$8.60

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$307.25

Service Code	HCPCS 85540
Hospital Charge Code	3003456
Hospital Revenue Code	305
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$46.09
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

Know your out-of-pocket cost for care.

All Charges