Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$569.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.91
Rate for Payer: Qualcare PPO/HMO/WC	$353.25

Immunoglobulin M

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888028
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Immunoglobulin M

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39888028
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	$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	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

IMMUNOGLOBULIN M (IGM)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009685
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 M (IGM)

Facility

$81.25

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

IMMUNOGLOBULIN M (IGM)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3009685
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

IMMUNOGLOBULIN M (IGM)

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3001625D
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

IMMUNOGLOBULINS

Facility

$240.00

Service Code	HCPCS 82784
Hospital Charge Code	38472419
Hospital Revenue Code	301
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IMMUNOGLOBULINS

Facility

$240.00

Service Code	HCPCS 82784
Hospital Charge Code	38472419
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	$31.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
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

IMMUNOGLOBULINS(IGG,A,M),I

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

IMMUNOGLOBULINS(IGG,A,M),I

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007A
Hospital Revenue Code	301
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.29
Rate for Payer: Cigna Commercial	$31.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$114.00

IMMUNOGLOBULINS(IGG,A,M),II

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.29
Rate for Payer: Cigna Commercial	$31.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$114.00

IMMUNOGLOBULINS(IGG,A,M),II

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

IMMUNOGLOBULINS(IGG,A,M),III

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007C
Hospital Revenue Code	301
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.29
Rate for Payer: Cigna Commercial	$31.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$114.00

IMMUNOGLOBULINS(IGG,A,M),III

Facility

$63.90

Service Code	HCPCS 8278491
Hospital Charge Code	39990007C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

IMMUNOGLOBULIN SUBCLASS 1

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665B
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	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
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

IMMUNOGLOBULIN SUBCLASS 1

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

IMMUNOGLOBULIN SUBCLASS 2

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665C
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	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
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

IMMUNOGLOBULIN SUBCLASS 2

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

IMMUNOGLOBULIN SUBCLASS 3

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665D
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

IMMUNOGLOBULIN SUBCLASS 3

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665D
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	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
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

IMMUNOGLOBULIN SUBCLASS 4

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665E
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

IMMUNOGLOBULIN SUBCLASS 4

Facility

$60.00

Service Code	HCPCS 82787
Hospital Charge Code	3006665E
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	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
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

IMMUNOHIST 1ST STAIN/SPEC

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061051
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOHIST 1ST STAIN/SPEC

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061051
Hospital Revenue Code	310
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$324.69
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges