Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

LEUPROLIDE DEPOT INJ 3.75MG

Facility

$4,064.65

Hospital Charge Code	6007264
Hospital Revenue Code	636
Min. Negotiated Rate	$609.70
Max. Negotiated Rate	$983.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.65
Rate for Payer: Qualcare PPO/HMO/WC	$609.70

LEUPROLIDE DEPOT INJ 3.75MG

Facility

$4,064.65

Hospital Charge Code	6007264
Hospital Revenue Code	636
Min. Negotiated Rate	$609.70
Max. Negotiated Rate	$2,032.33
Rate for Payer: Aetna Commercial	$1,219.39
Rate for Payer: Aetna Medicare Advantage	$1,219.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,036.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,036.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,036.49
Rate for Payer: Cigna Commercial	$2,032.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.65
Rate for Payer: Qualcare PPO/HMO/WC	$609.70

LEUPROLIDE DEPOT INJ 7.5MG

Facility

$2,955.55

Hospital Charge Code	6007256
Hospital Revenue Code	636
Min. Negotiated Rate	$443.33
Max. Negotiated Rate	$715.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.24
Rate for Payer: Qualcare PPO/HMO/WC	$443.33

LEUPROLIDE DEPOT INJ 7.5MG

Facility

$2,955.55

Hospital Charge Code	6007256
Hospital Revenue Code	636
Min. Negotiated Rate	$443.33
Max. Negotiated Rate	$1,477.78
Rate for Payer: Aetna Commercial	$886.66
Rate for Payer: Aetna Medicare Advantage	$886.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$753.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$753.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$753.67
Rate for Payer: Cigna Commercial	$1,477.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.24
Rate for Payer: Qualcare PPO/HMO/WC	$443.33

LEVAFLOXACIN 750MG TABLET

Facility

$111.00

Hospital Charge Code	60635645
Hospital Revenue Code	250
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna Commercial	$33.30
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$55.50

LEVAFLOXACIN 750MG TABLET

Facility

$111.00

Hospital Charge Code	60635645
Hospital Revenue Code	250
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

LEVALBUTEROL

Facility

$44.96

Service Code	NDC 378968144
Hospital Charge Code	60628899
Hospital Revenue Code	250
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$22.48
Rate for Payer: Aetna Commercial	$13.49
Rate for Payer: Aetna Medicare Advantage	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.46
Rate for Payer: Cigna Commercial	$22.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Oxford Commercial	$22.48
Rate for Payer: Qualcare PPO/HMO/WC	$6.74
Rate for Payer: UnitedHealthcare Commercial	$22.48

LEVALBUTEROL

Facility

$44.96

Service Code	NDC 378968144
Hospital Charge Code	60628899
Hospital Revenue Code	250
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$6.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.74

LEVALBUTEROL1.25 MG/3 ML

Facility

$65.79

Service Code	NDC 54569544500
Hospital Charge Code	60628930
Hospital Revenue Code	250
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$32.90
Rate for Payer: Aetna Commercial	$19.74
Rate for Payer: Aetna Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.78
Rate for Payer: Cigna Commercial	$32.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.55
Rate for Payer: Oxford Commercial	$32.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.87
Rate for Payer: UnitedHealthcare Commercial	$32.90

LEVALBUTEROL1.25 MG/3 ML

Facility

$65.79

Service Code	NDC 54569544500
Hospital Charge Code	60628930
Hospital Revenue Code	250
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$9.87
Rate for Payer: Qualcare PPO/HMO/WC	$9.87

LEVAMISOLE HCL TAB 50MG

Facility

$52.50

Hospital Charge Code	6007439
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

LEVAMISOLE HCL TAB 50MG

Facility

$52.50

Hospital Charge Code	6007439
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

LEVAMISOLE TAB 50MG

Facility

$35.85

Hospital Charge Code	60628632
Hospital Revenue Code	250
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$17.93
Rate for Payer: Aetna Commercial	$10.76
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.66
Rate for Payer: Oxford Commercial	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.38
Rate for Payer: UnitedHealthcare Commercial	$17.93

LEVAMISOLE TAB 50MG

Facility

$35.85

Hospital Charge Code	60628632
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

LEVAQUIN 250MG TAB U/D

Facility

$42.00

Hospital Charge Code	60635253
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

LEVAQUIN 250MG TAB U/D

Facility

$42.00

Hospital Charge Code	60635253
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

LEVAQUIN 500MG TAB U/D

Facility

$51.00

Hospital Charge Code	60635254
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

LEVAQUIN 500MG TAB U/D

Facility

$51.00

Hospital Charge Code	60635254
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$25.50

LEVEEN INFLATION SYRINGE 10CC

Facility

$212.00

Hospital Charge Code	270332069
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

LEVEEN INFLATION SYRINGE 10CC

Facility

$212.00

Hospital Charge Code	270332069
Hospital Revenue Code	272
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$63.60
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$106.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$106.00

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$93.30
Rate for Payer: Aetna Commercial	$93.30
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.43
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421599211
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421099211
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

Know your out-of-pocket cost for care.

All Charges