Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOGLOBULIN G CSF

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009678
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN G CSF

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009678
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

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009677
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

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009677
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3001625B
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN G (IGG)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3001625B
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

IMMUNOGLOBULIN INJ 10% 50ML

Facility

$17,237.00

Service Code	HCPCS J1563
Hospital Charge Code	60629087
Hospital Revenue Code	636
Min. Negotiated Rate	$2,585.55
Max. Negotiated Rate	$8,618.50
Rate for Payer: Aetna Commercial	$5,171.10
Rate for Payer: Aetna Medicare Advantage	$5,171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,395.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,395.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,395.44
Rate for Payer: Cigna Commercial	$8,618.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,171.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,585.55

IMMUNOGLOBULIN INJ 10% 50ML

Facility

$17,237.00

Service Code	HCPCS J1563
Hospital Charge Code	60629087
Hospital Revenue Code	636
Min. Negotiated Rate	$2,585.55
Max. Negotiated Rate	$4,171.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,171.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,585.55

IMMUNOGLOBULIN INJ 12G

Facility

$9,481.00

Service Code	HCPCS J1563
Hospital Charge Code	60628787
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.15
Max. Negotiated Rate	$2,294.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,294.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.15

IMMUNOGLOBULIN INJ 12G

Facility

$4,828.00

Service Code	HCPCS J1563
Hospital Charge Code	60628293
Hospital Revenue Code	636
Min. Negotiated Rate	$724.20
Max. Negotiated Rate	$2,414.00
Rate for Payer: Aetna Commercial	$1,448.40
Rate for Payer: Aetna Medicare Advantage	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,231.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,231.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,231.14
Rate for Payer: Cigna Commercial	$2,414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,168.38
Rate for Payer: Qualcare PPO/HMO/WC	$724.20

IMMUNOGLOBULIN INJ 12G

Facility

$4,828.00

Service Code	HCPCS J1563
Hospital Charge Code	60628293
Hospital Revenue Code	636
Min. Negotiated Rate	$724.20
Max. Negotiated Rate	$1,168.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,168.38
Rate for Payer: Qualcare PPO/HMO/WC	$724.20

IMMUNOGLOBULIN INJ 12G

Facility

$9,481.00

Service Code	HCPCS J1563
Hospital Charge Code	60628787
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.15
Max. Negotiated Rate	$4,740.50
Rate for Payer: Aetna Commercial	$2,844.30
Rate for Payer: Aetna Medicare Advantage	$2,844.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,417.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,417.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,417.66
Rate for Payer: Cigna Commercial	$4,740.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,294.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.15

IMMUNOGLOBULIN INJ 6G

Facility

$4,742.00

Service Code	HCPCS J1563
Hospital Charge Code	60629112
Hospital Revenue Code	636
Min. Negotiated Rate	$711.30
Max. Negotiated Rate	$1,147.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.56
Rate for Payer: Qualcare PPO/HMO/WC	$711.30

IMMUNOGLOBULIN INJ 6G

Facility

$2,918.00

Service Code	HCPCS J1563
Hospital Charge Code	60628906
Hospital Revenue Code	636
Min. Negotiated Rate	$437.70
Max. Negotiated Rate	$706.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.16
Rate for Payer: Qualcare PPO/HMO/WC	$437.70

IMMUNOGLOBULIN INJ 6G

Facility

$2,918.00

Service Code	HCPCS J1563
Hospital Charge Code	60628906
Hospital Revenue Code	636
Min. Negotiated Rate	$437.70
Max. Negotiated Rate	$1,459.00
Rate for Payer: Aetna Commercial	$875.40
Rate for Payer: Aetna Medicare Advantage	$875.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$744.09
Rate for Payer: Cigna Commercial	$1,459.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.16
Rate for Payer: Qualcare PPO/HMO/WC	$437.70

IMMUNOGLOBULIN INJ 6G

Facility

$4,742.00

Service Code	HCPCS J1563
Hospital Charge Code	60629112
Hospital Revenue Code	636
Min. Negotiated Rate	$711.30
Max. Negotiated Rate	$2,371.00
Rate for Payer: Aetna Commercial	$1,422.60
Rate for Payer: Aetna Medicare Advantage	$1,422.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,209.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,209.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,209.21
Rate for Payer: Cigna Commercial	$2,371.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.56
Rate for Payer: Qualcare PPO/HMO/WC	$711.30

IMMUNOGLOBULIN IV 10GM/10GM(1)

Facility

$5,556.00

Service Code	HCPCS J1563
Hospital Charge Code	60628292
Hospital Revenue Code	636
Min. Negotiated Rate	$833.40
Max. Negotiated Rate	$1,344.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.55
Rate for Payer: Qualcare PPO/HMO/WC	$833.40

IMMUNOGLOBULIN IV 10GM/10GM(1)

Facility

$5,556.00

Service Code	HCPCS J1563
Hospital Charge Code	60628292
Hospital Revenue Code	636
Min. Negotiated Rate	$833.40
Max. Negotiated Rate	$2,778.00
Rate for Payer: Aetna Commercial	$1,666.80
Rate for Payer: Aetna Medicare Advantage	$1,666.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.78
Rate for Payer: Cigna Commercial	$2,778.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.55
Rate for Payer: Qualcare PPO/HMO/WC	$833.40

IMMUNOGLOBULIN IV 10GM/200ML

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	60628290
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

IMMUNOGLOBULIN IV 10GM/200ML

Facility

$7,059.00

Service Code	HCPCS J1563
Hospital Charge Code	60628290
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

IMMUNOGLOBULIN IV 10GM/5GM(2)

Facility

$5,577.00

Service Code	HCPCS J1563
Hospital Charge Code	60628289
Hospital Revenue Code	636
Min. Negotiated Rate	$836.55
Max. Negotiated Rate	$1,349.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,349.63
Rate for Payer: Qualcare PPO/HMO/WC	$836.55

IMMUNOGLOBULIN IV 10GM/5GM(2)

Facility

$5,577.00

Service Code	HCPCS J1563
Hospital Charge Code	60628289
Hospital Revenue Code	636
Min. Negotiated Rate	$836.55
Max. Negotiated Rate	$2,788.50
Rate for Payer: Aetna Commercial	$1,673.10
Rate for Payer: Aetna Medicare Advantage	$1,673.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,422.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,422.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,422.13
Rate for Payer: Cigna Commercial	$2,788.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,349.63
Rate for Payer: Qualcare PPO/HMO/WC	$836.55

IMMUNOGLOBULIN IV 2.5GM

Facility

$1,391.00

Service Code	HCPCS J1563
Hospital Charge Code	60628295
Hospital Revenue Code	636
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$336.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

IMMUNOGLOBULIN IV 2.5GM

Facility

$1,391.00

Service Code	HCPCS J1563
Hospital Charge Code	60628295
Hospital Revenue Code	636
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$695.50
Rate for Payer: Aetna Commercial	$417.30
Rate for Payer: Aetna Medicare Advantage	$417.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.70
Rate for Payer: Cigna Commercial	$695.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

IMMUNOGLOBULIN IV 5GM

Facility

$2,355.00

Service Code	HCPCS J1563
Hospital Charge Code	60628291
Hospital Revenue Code	636
Min. Negotiated Rate	$353.25
Max. Negotiated Rate	$1,177.50
Rate for Payer: Aetna Commercial	$706.50
Rate for Payer: Aetna Medicare Advantage	$706.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.52
Rate for Payer: Cigna Commercial	$1,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.91
Rate for Payer: Qualcare PPO/HMO/WC	$353.25

Know your out-of-pocket cost for care.

All Charges