Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEVOBUPIVACAINE 5MG/1ML INJ

Facility

$35.85

Hospital Charge Code	60629249
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

LEVOCARNITINE 1G/5ML INJ

Facility

$151.05

Hospital Charge Code	60629183
Hospital Revenue Code	250
Min. Negotiated Rate	$19.64
Max. Negotiated Rate	$75.53
Rate for Payer: Aetna Commercial	$45.31
Rate for Payer: Aetna Medicare Advantage	$45.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.52
Rate for Payer: Cigna Commercial	$75.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.64
Rate for Payer: Oxford Commercial	$75.53
Rate for Payer: Qualcare PPO/HMO/WC	$22.66
Rate for Payer: UnitedHealthcare Commercial	$75.53

LEVOCARNITINE 1G/5ML INJ

Facility

$151.05

Hospital Charge Code	60629183
Hospital Revenue Code	250
Min. Negotiated Rate	$22.66
Max. Negotiated Rate	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$22.66

LEVODOPA 500 MG TAB

Facility

$5.65

Hospital Charge Code	60627871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

LEVODOPA 500 MG TAB

Facility

$5.65

Hospital Charge Code	60627871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

LEVODOPA TAB 250MG

Facility

$3.85

Hospital Charge Code	60627870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

LEVODOPA TAB 250MG

Facility

$3.85

Hospital Charge Code	60627870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

LEVO-DROMORAN/2MG/1ML

Facility

$13.00

Hospital Charge Code	60633282
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LEVO-DROMORAN/2MG/1ML

Facility

$13.00

Hospital Charge Code	60633282
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

LEVOFLOXACIN 250MG/50 ML IVPB

Facility

$174.10

Hospital Charge Code	60629226
Hospital Revenue Code	258
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$26.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.11

LEVOFLOXACIN 250MG/50 ML IVPB

Facility

$174.10

Hospital Charge Code	60629226
Hospital Revenue Code	258
Min. Negotiated Rate	$22.63
Max. Negotiated Rate	$87.05
Rate for Payer: Cigna Commercial	$87.05
Rate for Payer: Aetna Commercial	$52.23
Rate for Payer: Aetna Medicare Advantage	$52.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.63
Rate for Payer: Oxford Commercial	$87.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.11
Rate for Payer: UnitedHealthcare Commercial	$87.05

LEVOFLOXACIN 250MG/D5W 50ML IV

Facility

$152.85

Hospital Charge Code	60628993
Hospital Revenue Code	250
Min. Negotiated Rate	$22.93
Max. Negotiated Rate	$22.93
Rate for Payer: Qualcare PPO/HMO/WC	$22.93

LEVOFLOXACIN 250MG/D5W 50ML IV

Facility

$152.85

Hospital Charge Code	60628993
Hospital Revenue Code	250
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$76.42
Rate for Payer: Aetna Commercial	$45.85
Rate for Payer: Aetna Medicare Advantage	$45.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$76.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.87
Rate for Payer: Oxford Commercial	$76.42
Rate for Payer: Qualcare PPO/HMO/WC	$22.93
Rate for Payer: UnitedHealthcare Commercial	$76.42

LEVOFLOXACIN 250 MG TAB

Facility

$191.75

Service Code	NDC 50458092010
Hospital Charge Code	60628633
Hospital Revenue Code	250
Min. Negotiated Rate	$24.93
Max. Negotiated Rate	$95.88
Rate for Payer: Aetna Commercial	$57.52
Rate for Payer: Aetna Medicare Advantage	$57.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.90
Rate for Payer: Cigna Commercial	$95.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: Oxford Commercial	$95.88
Rate for Payer: Qualcare PPO/HMO/WC	$28.76
Rate for Payer: UnitedHealthcare Commercial	$95.88

LEVOFLOXACIN 250 MG TAB

Facility

$191.75

Service Code	NDC 50458092010
Hospital Charge Code	60628633
Hospital Revenue Code	250
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$28.76
Rate for Payer: Qualcare PPO/HMO/WC	$28.76

LEVOFLOXACIN 500 MG TAB

Facility

$58.45

Hospital Charge Code	60628634
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

LEVOFLOXACIN 500 MG TAB

Facility

$58.45

Hospital Charge Code	60628634
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$29.23
Rate for Payer: Aetna Commercial	$17.54
Rate for Payer: Aetna Medicare Advantage	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.60
Rate for Payer: Oxford Commercial	$29.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$29.23

LEVOFLOXACIN 750MG/D5W 150MLIV

Facility

$322.60

Hospital Charge Code	60629092
Hospital Revenue Code	250
Min. Negotiated Rate	$48.39
Max. Negotiated Rate	$48.39
Rate for Payer: Qualcare PPO/HMO/WC	$48.39

LEVOFLOXACIN 750MG/D5W 150MLIV

Facility

$322.60

Hospital Charge Code	60629092
Hospital Revenue Code	250
Min. Negotiated Rate	$41.94
Max. Negotiated Rate	$161.30
Rate for Payer: Aetna Commercial	$96.78
Rate for Payer: Aetna Medicare Advantage	$96.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.26
Rate for Payer: Cigna Commercial	$161.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.94
Rate for Payer: Oxford Commercial	$161.30
Rate for Payer: Qualcare PPO/HMO/WC	$48.39
Rate for Payer: UnitedHealthcare Commercial	$161.30

LEVOFLOXACIN(LEVAQUIN)250 IVPB

Facility

$154.64

Service Code	NDC 25021013281
Hospital Charge Code	60630153
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

LEVOFLOXACIN(LEVAQUIN)250 IVPB

Facility

$154.64

Service Code	NDC 25021013281
Hospital Charge Code	60630153
Hospital Revenue Code	250
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$77.32
Rate for Payer: Aetna Commercial	$46.39
Rate for Payer: Aetna Medicare Advantage	$46.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.43
Rate for Payer: Cigna Commercial	$77.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$77.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Commercial	$77.32

LEVOFLOXACIN(LEVAQUIN)500 IVPB

Facility

$154.64

Service Code	NDC 25021013282
Hospital Charge Code	60630152
Hospital Revenue Code	250
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$77.32
Rate for Payer: Aetna Commercial	$46.39
Rate for Payer: Aetna Medicare Advantage	$46.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.43
Rate for Payer: Cigna Commercial	$77.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$77.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Commercial	$77.32

LEVOFLOXACIN(LEVAQUIN)500 IVPB

Facility

$154.64

Service Code	NDC 25021013282
Hospital Charge Code	60630152
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

LEVOFLOXACIN(LEVAQUIN)500 TAB

Facility

$129.24

Service Code	NDC 93729253
Hospital Charge Code	60630154
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$64.62
Rate for Payer: Aetna Commercial	$38.77
Rate for Payer: Aetna Medicare Advantage	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.96
Rate for Payer: Cigna Commercial	$64.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$64.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.39
Rate for Payer: UnitedHealthcare Commercial	$64.62

LEVOFLOXACIN(LEVAQUIN)500 TAB

Facility

$129.24

Service Code	NDC 93729253
Hospital Charge Code	60630154
Hospital Revenue Code	250
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.39

Know your out-of-pocket cost for care.

All Charges