Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEUKOCYTE ALKALINE PHOSPHATASE

Facility

$307.25

Service Code	HCPCS 85540
Hospital Charge Code	3003456
Hospital Revenue Code	305
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$8.60
Rate for Payer: Cigna Medicare Advantage	$4.30
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: 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	$39.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.09
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

$168.00

Service Code	HCPCS 85540
Hospital Charge Code	38473024
Hospital Revenue Code	305
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

LEUKOCYTE HISTMINE RELEASE TST

Facility

$88.00

Service Code	HCPCS 86343
Hospital Charge Code	38477106
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

LEUKOCYTE HISTMINE RELEASE TST

Facility

$88.00

Service Code	HCPCS 86343
Hospital Charge Code	38477106
Hospital Revenue Code	302
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.37
Rate for Payer: Aetna Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$12.46
Rate for Payer: Cigna Medicare Advantage	$6.23
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.46
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.21
Rate for Payer: Wellcare Medicare Advantage	$12.46

LEUKOCYTE REMOVAL FILTER

Facility

$142.00

Service Code	HCPCS 99999
Hospital Charge Code	3400207
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$42.60
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$71.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$71.00

LEUKOCYTE REMOVAL FILTER

Facility

$142.00

Service Code	HCPCS 99999
Hospital Charge Code	3400207
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

LEUKOCYTE TRANSFUSION

Facility

$89.00

Service Code	HCPCS 86950
Hospital Charge Code	38477107
Hospital Revenue Code	300
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEUKOCYTE TRANSFUSION

Facility

$89.00

Service Code	HCPCS 86950
Hospital Charge Code	38477107
Hospital Revenue Code	300
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

LEUKO FILTER PLT PHERESIS

Facility

$289.65

Hospital Charge Code	3100260
Hospital Revenue Code	272
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$86.89
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.65
Rate for Payer: Oxford Commercial	$144.82
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Commercial	$144.82

LEUKO FILTER PLT PHERESIS

Facility

$289.65

Hospital Charge Code	3100260
Hospital Revenue Code	272
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$43.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

LEUKO FILTER PLTS < 7 UNITS

Facility

$273.65

Hospital Charge Code	3100252
Hospital Revenue Code	272
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$136.82
Rate for Payer: Aetna Commercial	$82.09
Rate for Payer: Aetna Medicare Advantage	$82.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.78
Rate for Payer: Cigna Commercial	$136.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.57
Rate for Payer: Oxford Commercial	$136.82
Rate for Payer: Qualcare PPO/HMO/WC	$41.05
Rate for Payer: UnitedHealthcare Commercial	$136.82

LEUKO FILTER PLTS < 7 UNITS

Facility

$273.65

Hospital Charge Code	3100252
Hospital Revenue Code	272
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$41.05
Rate for Payer: Qualcare PPO/HMO/WC	$41.05

LEUKOPHERESIS

Facility

$329.00

Service Code	HCPCS 36520
Hospital Charge Code	3400223
Hospital Revenue Code	380
Min. Negotiated Rate	$42.77
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$98.70
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.77
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$756.00

LEUKOPHERESIS

Facility

$329.00

Service Code	HCPCS 36520
Hospital Charge Code	3400223
Hospital Revenue Code	380
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

LEUKO REDUCED PLT PHERESIS

Facility

$6,563.84

Hospital Charge Code	3100125
Hospital Revenue Code	390
Min. Negotiated Rate	$984.58
Max. Negotiated Rate	$984.58
Rate for Payer: Qualcare PPO/HMO/WC	$984.58

LEUKO REDUCED PLT PHERESIS

Facility

$6,563.84

Hospital Charge Code	3100125
Hospital Revenue Code	390
Min. Negotiated Rate	$666.00
Max. Negotiated Rate	$3,281.92
Rate for Payer: Aetna Commercial	$1,969.15
Rate for Payer: Aetna Medicare Advantage	$1,969.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,673.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,673.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,673.78
Rate for Payer: Cigna Commercial	$3,281.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.30
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$984.58
Rate for Payer: UnitedHealthcare Commercial	$756.00

LEUKO REDUCED RBC

Facility

$3,113.89

Service Code	HCPCS P9016
Hospital Charge Code	3100303
Hospital Revenue Code	390
Min. Negotiated Rate	$467.08
Max. Negotiated Rate	$467.08
Rate for Payer: Qualcare PPO/HMO/WC	$467.08

LEUKO REDUCED RBC

Facility

$3,113.89

Service Code	HCPCS P9016
Hospital Charge Code	3100303
Hospital Revenue Code	390
Min. Negotiated Rate	$404.81
Max. Negotiated Rate	$934.17
Rate for Payer: Aetna Commercial	$934.17
Rate for Payer: Aetna Medicare Advantage	$934.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$794.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$794.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$794.04
Rate for Payer: Cigna Commercial	$431.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.81
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$467.08
Rate for Payer: UnitedHealthcare Commercial	$756.00

LEUNG BILARY STENT COTTON 7FR

Facility

$279.00

Hospital Charge Code	270331662
Hospital Revenue Code	278
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$83.70
Rate for Payer: Aetna Medicare Advantage	$83.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.14
Rate for Payer: Cigna Commercial	$139.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.52
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

LEUNG BILARY STENT COTTON 7FR

Facility

$279.00

Hospital Charge Code	270331662
Hospital Revenue Code	278
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.52
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

LEUPROLIDE 3.75MG

Facility

$2,364.80

Hospital Charge Code	6006977
Hospital Revenue Code	636
Min. Negotiated Rate	$354.72
Max. Negotiated Rate	$572.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.28
Rate for Payer: Qualcare PPO/HMO/WC	$354.72

LEUPROLIDE 3.75MG

Facility

$2,364.80

Hospital Charge Code	6006977
Hospital Revenue Code	636
Min. Negotiated Rate	$354.72
Max. Negotiated Rate	$1,182.40
Rate for Payer: Aetna Commercial	$709.44
Rate for Payer: Aetna Medicare Advantage	$709.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$603.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$603.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$603.02
Rate for Payer: Cigna Commercial	$1,182.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.28
Rate for Payer: Qualcare PPO/HMO/WC	$354.72

LEUPROLIDE ACETATE 3.75 MG

Facility

$4,611.48

Service Code	HCPCS J1950
Hospital Charge Code	60627392
Hospital Revenue Code	636
Min. Negotiated Rate	$691.72
Max. Negotiated Rate	$1,115.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.98
Rate for Payer: Qualcare PPO/HMO/WC	$691.72

LEUPROLIDE ACETATE 3.75 MG

Facility

$4,611.48

Service Code	HCPCS J1950
Hospital Charge Code	60627392
Hospital Revenue Code	636
Min. Negotiated Rate	$691.72
Max. Negotiated Rate	$1,383.44
Rate for Payer: Aetna Commercial	$1,383.44
Rate for Payer: Aetna Medicare Advantage	$1,383.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,175.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,175.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,175.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.98
Rate for Payer: Qualcare PPO/HMO/WC	$691.72

LEUPROLIDE ACETATE 7.5 MG

Facility

$5,495.41

Service Code	HCPCS J9217
Hospital Charge Code	60627393
Hospital Revenue Code	636
Min. Negotiated Rate	$824.31
Max. Negotiated Rate	$1,648.62
Rate for Payer: Aetna Commercial	$1,648.62
Rate for Payer: Aetna Medicare Advantage	$1,648.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,401.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,401.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,401.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,329.89
Rate for Payer: Qualcare PPO/HMO/WC	$824.31

Know your out-of-pocket cost for care.

All Charges