Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMMUNE GLOBULIN INJ 10ML

Facility

$22.00

Hospital Charge Code	6002620
Hospital Revenue Code	259
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

IMMUNE GLOBULIN INJ 2ML

Facility

$52.00

Hospital Charge Code	6002612
Hospital Revenue Code	259
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

IMMUNE GLOBULIN INJ 2ML

Facility

$52.00

Hospital Charge Code	6002612
Hospital Revenue Code	259
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

IMMUNE GLOBULIN INJ IM

Facility

$2,912.00

Hospital Charge Code	60628288
Hospital Revenue Code	250
Min. Negotiated Rate	$436.80
Max. Negotiated Rate	$436.80
Rate for Payer: Qualcare PPO/HMO/WC	$436.80

IMMUNE GLOBULIN INJ IM

Facility

$2,912.00

Hospital Charge Code	60628288
Hospital Revenue Code	250
Min. Negotiated Rate	$378.56
Max. Negotiated Rate	$1,456.00
Rate for Payer: Aetna Commercial	$873.60
Rate for Payer: Aetna Medicare Advantage	$873.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.56
Rate for Payer: Cigna Commercial	$1,456.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.56
Rate for Payer: Oxford Commercial	$1,456.00
Rate for Payer: Qualcare PPO/HMO/WC	$436.80
Rate for Payer: UnitedHealthcare Commercial	$1,456.00

IMMUNE GLOBULIN VL 10GM

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	6010516
Hospital Revenue Code	636
Min. Negotiated Rate	$1,058.85
Max. Negotiated Rate	$1,708.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,708.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,058.85

IMMUNE GLOBULIN VL 10GM

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	6010516
Hospital Revenue Code	636
Min. Negotiated Rate	$1,058.85
Max. Negotiated Rate	$3,529.50
Rate for Payer: Aetna Commercial	$2,117.70
Rate for Payer: Aetna Medicare Advantage	$2,117.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,800.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,800.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,800.05
Rate for Payer: Cigna Commercial	$3,529.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,708.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,058.85

IMMUNE GLOBULIN VL 12.5GM

Facility

$1,362.00

Hospital Charge Code	6006985
Hospital Revenue Code	251
Min. Negotiated Rate	$204.30
Max. Negotiated Rate	$204.30
Rate for Payer: Qualcare PPO/HMO/WC	$204.30

IMMUNE GLOBULIN VL 12.5GM

Facility

$1,362.00

Hospital Charge Code	6006985
Hospital Revenue Code	251
Min. Negotiated Rate	$177.06
Max. Negotiated Rate	$681.00
Rate for Payer: Aetna Commercial	$408.60
Rate for Payer: Aetna Medicare Advantage	$408.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.31
Rate for Payer: Cigna Commercial	$681.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.06
Rate for Payer: Oxford Commercial	$681.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.30
Rate for Payer: UnitedHealthcare Commercial	$681.00

IMMUNE GLOBULIN VL 5GM

Facility

$761.00

Hospital Charge Code	6000319
Hospital Revenue Code	251
Min. Negotiated Rate	$98.93
Max. Negotiated Rate	$380.50
Rate for Payer: Aetna Commercial	$228.30
Rate for Payer: Aetna Medicare Advantage	$228.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.06
Rate for Payer: Cigna Commercial	$380.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.93
Rate for Payer: Oxford Commercial	$380.50
Rate for Payer: Qualcare PPO/HMO/WC	$114.15
Rate for Payer: UnitedHealthcare Commercial	$380.50

IMMUNE GLOBULIN VL 5GM

Facility

$761.00

Hospital Charge Code	6000319
Hospital Revenue Code	251
Min. Negotiated Rate	$114.15
Max. Negotiated Rate	$114.15
Rate for Payer: Qualcare PPO/HMO/WC	$114.15

IMMUNFIX E-PHORSIS/URINE/CSF

Facility

$390.00

Service Code	HCPCS 86335
Hospital Charge Code	401086335
Hospital Revenue Code	302
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.09
Rate for Payer: Aetna Medicare Advantage	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.54
Rate for Payer: Cigna Commercial	$29.35
Rate for Payer: Cigna Medicare Advantage	$14.68
Rate for Payer: Clover Medicare Advantage	$27.88
Rate for Payer: EmblemHealth Commercial	$88.05
Rate for Payer: Humana Medicare Advantage	$30.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.11
Rate for Payer: Wellcare Medicare Advantage	$29.35

IMMUNFIX E-PHORSIS/URINE/CSF

Facility

$390.00

Service Code	HCPCS 86335
Hospital Charge Code	401086335
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNIZA ADMIN-INTRANASAL ORAL

Facility

$201.60

Service Code	HCPCS 90473
Hospital Charge Code	260123
Hospital Revenue Code	771
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$30.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.24

IMMUNIZA ADMIN-INTRANASAL ORAL

Facility

$201.60

Service Code	HCPCS 90473
Hospital Charge Code	260123
Hospital Revenue Code	771
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$60.48
Rate for Payer: Aetna Medicare Advantage	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.41
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.21
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.24
Rate for Payer: UnitedHealthcare Commercial	$103.00

IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJECTIONS); 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)

Facility

$1,864.00

Service Code	CPT 90471
Hospital Revenue Code	360
Min. Negotiated Rate	$171.47
Max. Negotiated Rate	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Cigna Commercial	$171.47

IMMUNIZATION ADM THROUG 18YRS

Facility

$55.00

Service Code	HCPCS 90460
Hospital Charge Code	5780270
Hospital Revenue Code	771
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$16.50
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$26.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.15
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$103.00

IMMUNIZATION ADM THROUG 18YRS

Facility

$55.00

Service Code	HCPCS 90460
Hospital Charge Code	5780270
Hospital Revenue Code	771
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

IMMUNNOELECTROPHRESIS;OTHER FL

Facility

$158.35

Service Code	HCPCS 86325
Hospital Charge Code	38477171
Hospital Revenue Code	302
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$23.75
Rate for Payer: Qualcare PPO/HMO/WC	$23.75

IMMUNNOELECTROPHRESIS;OTHER FL

Facility

$158.35

Service Code	HCPCS 86325
Hospital Charge Code	38477171
Hospital Revenue Code	302
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.94
Rate for Payer: Aetna Medicare Advantage	$23.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.75
Rate for Payer: Cigna Commercial	$23.13
Rate for Payer: Cigna Medicare Advantage	$11.56
Rate for Payer: Clover Medicare Advantage	$21.97
Rate for Payer: EmblemHealth Commercial	$69.39
Rate for Payer: Humana Medicare Advantage	$23.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.52
Rate for Payer: Wellcare Medicare Advantage	$23.13

IMMUNOASSAY

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3035001G
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

IMMUNOASSAY

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3035001D
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

IMMUNOASSAY

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3035001D
Hospital Revenue Code	301
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Qualcare PPO/HMO/WC	$175.65

IMMUNOASSAY

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3035001E
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

IMMUNOASSAY

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3035001C
Hospital Revenue Code	301
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Qualcare PPO/HMO/WC	$175.65

Know your out-of-pocket cost for care.

All Charges