Heights University Hospital

All Charges

Charge

Type

Setting

Price

IGG SUBCLASSES PANEL III

Facility

$667.59

Service Code	HCPCS 82787
Hospital Charge Code	39990068C
Hospital Revenue Code	301
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$127.16
Rate for Payer: Aetna Commercial	$25.98
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.39
Rate for Payer: Cigna Commercial	$8.02
Rate for Payer: Cigna Medicare Advantage	$4.01
Rate for Payer: Clover Medicare Advantage	$7.62
Rate for Payer: EmblemHealth Commercial	$24.06
Rate for Payer: Humana Medicare Advantage	$8.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.50
Rate for Payer: Wellcare Medicare Advantage	$8.02

IGG SUBCLASSES PANEL III

Facility

$667.59

Service Code	HCPCS 82787
Hospital Charge Code	39990068C
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

IGG SUBCLASSES PANEL IV

Facility

$667.59

Service Code	HCPCS 82787
Hospital Charge Code	39990068D
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

IGG SUBCLASSES PANEL IV

Facility

$667.59

Service Code	HCPCS 82787
Hospital Charge Code	39990068D
Hospital Revenue Code	301
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$127.16
Rate for Payer: Aetna Commercial	$25.98
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.39
Rate for Payer: Cigna Commercial	$8.02
Rate for Payer: Cigna Medicare Advantage	$4.01
Rate for Payer: Clover Medicare Advantage	$7.62
Rate for Payer: EmblemHealth Commercial	$24.06
Rate for Payer: Humana Medicare Advantage	$8.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.50
Rate for Payer: Wellcare Medicare Advantage	$8.02

IGG SUBCLASSES PANEL V

Facility

$667.59

Service Code	HCPCS 82787
Hospital Charge Code	39990068E
Hospital Revenue Code	301
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$127.16
Rate for Payer: Aetna Commercial	$25.98
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.39
Rate for Payer: Cigna Commercial	$8.02
Rate for Payer: Cigna Medicare Advantage	$4.01
Rate for Payer: Clover Medicare Advantage	$7.62
Rate for Payer: EmblemHealth Commercial	$24.06
Rate for Payer: Humana Medicare Advantage	$8.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.50
Rate for Payer: Wellcare Medicare Advantage	$8.02

IGG SUBCLASSES PANEL V

Facility

$667.59

Service Code	HCPCS 82787
Hospital Charge Code	39990068E
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

IGG SUBCLASSES PROFILE

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3006665A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

IGG SUBCLASSES PROFILE

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3006665A
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IGIV HUMAN FOR INTRAVENEOS USE

Facility

$180.00

Service Code	HCPCS 90283
Hospital Charge Code	3408005
Hospital Revenue Code	636
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

IGIV HUMAN FOR INTRAVENEOS USE

Facility

$180.00

Service Code	HCPCS 90283
Hospital Charge Code	3408005
Hospital Revenue Code	636
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$43.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

IGK REARRANGEABN CLONAL POP

Facility

$760.50

Service Code	HCPCS 81264
Hospital Charge Code	401081264
Hospital Revenue Code	310
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

IGK REARRANGEABN CLONAL POP

Facility

$760.50

Service Code	HCPCS 81264
Hospital Charge Code	401081264
Hospital Revenue Code	310
Min. Negotiated Rate	$86.36
Max. Negotiated Rate	$632.88
Rate for Payer: Aetna Commercial	$559.65
Rate for Payer: Aetna Medicare Advantage	$172.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$172.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.88
Rate for Payer: Cigna Commercial	$172.73
Rate for Payer: Cigna Medicare Advantage	$86.36
Rate for Payer: Clover Medicare Advantage	$164.09
Rate for Payer: EmblemHealth Commercial	$518.19
Rate for Payer: Humana Medicare Advantage	$177.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$183.09
Rate for Payer: Wellcare Medicare Advantage	$172.73

IgM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38472413
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

IgM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38472413
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

IGM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38479449
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

IGM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38479417
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

IGM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38479417
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

IGM

Facility

$253.00

Service Code	HCPCS 82784
Hospital Charge Code	38479449
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

IgM, Mycoplasma pneumoniae

Facility

$79.19

Service Code	HCPCS 21130
Hospital Charge Code	3000079
Hospital Revenue Code	306
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$23.76
Rate for Payer: Aetna Medicare Advantage	$23.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.19
Rate for Payer: Cigna Commercial	$39.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
Rate for Payer: UnitedHealthcare Commercial	$114.00

IgM, Mycoplasma pneumoniae

Facility

$79.19

Service Code	HCPCS 21130
Hospital Charge Code	3000079
Hospital Revenue Code	306
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

IIV4 VACCINE SPLT 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90688
Hospital Charge Code	412390688
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IIV4 VACCINE SPLT 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90688
Hospital Charge Code	412390688
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$25.09
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IIV4 VACC NO PRSV 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90686
Hospital Charge Code	412390686
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$25.09
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IIV4 VACC NO PRSV 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90686
Hospital Charge Code	412390686
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

I-KNIFE II 15 DEGREE 5MM

Facility

$35.50

Hospital Charge Code	270655016
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$17.75
Rate for Payer: Aetna Commercial	$10.65
Rate for Payer: Aetna Medicare Advantage	$10.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.05
Rate for Payer: Cigna Commercial	$17.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$17.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.33
Rate for Payer: UnitedHealthcare Commercial	$17.75

Know your out-of-pocket cost for care.

All Charges