Heights University Hospital

All Charges

Charge

Type

Setting

Price

PNEUMOGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83092025
Hospital Revenue Code	460
Min. Negotiated Rate	$184.95
Max. Negotiated Rate	$184.95
Rate for Payer: Qualcare PPO/HMO/WC	$184.95

PNEUMOGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83092025
Hospital Revenue Code	460
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$369.90
Rate for Payer: Aetna Medicare Advantage	$369.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$314.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$314.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$314.42
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.29
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$184.95
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PNEUMOGRAM 24 HR/2 CHAN*****

Facility

$1,020.00

Hospital Charge Code	270606216
Hospital Revenue Code	270
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

PNEUMOGRAM 24 HR/2 CHAN*****

Facility

$1,020.00

Hospital Charge Code	270606216
Hospital Revenue Code	270
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$510.00

PNEUMOGRAM 24 HR/4 CHANNEL

Facility

$3,281.25

Service Code	HCPCS 94772
Hospital Charge Code	110000
Hospital Revenue Code	469
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$984.38
Rate for Payer: Aetna Medicare Advantage	$984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.72
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$426.56
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$492.19
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PNEUMOGRAM 24 HR/4 CHANNEL

Facility

$3,281.25

Service Code	HCPCS 94772
Hospital Charge Code	110000
Hospital Revenue Code	469
Min. Negotiated Rate	$492.19
Max. Negotiated Rate	$492.19
Rate for Payer: Qualcare PPO/HMO/WC	$492.19

PNEUMONITIS HEPERSENS

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3009636A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

PNEUMONITIS HEPERSENS

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3009636A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.14
Rate for Payer: Aetna Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.40
Rate for Payer: Cigna Commercial	$12.39
Rate for Payer: Cigna Medicare Advantage	$6.20
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.13
Rate for Payer: Wellcare Medicare Advantage	$12.39

PNEUMONOCCOCAL VAC 0.5 ML VIAL

Facility

$541.90

Service Code	HCPCS 90732
Hospital Charge Code	83652335
Hospital Revenue Code	636
Min. Negotiated Rate	$81.28
Max. Negotiated Rate	$131.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.14
Rate for Payer: Qualcare PPO/HMO/WC	$81.28

PNEUMONOCCOCAL VAC 0.5 ML VIAL

Facility

$541.90

Service Code	HCPCS 90732
Hospital Charge Code	83652335
Hospital Revenue Code	636
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$162.57
Rate for Payer: Aetna Commercial	$162.57
Rate for Payer: Aetna Medicare Advantage	$162.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.18
Rate for Payer: Cigna Commercial	$133.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.14
Rate for Payer: Qualcare PPO/HMO/WC	$81.28

PNEUMOTHORAX KIT ARW AK01500**

Facility

$234.00

Hospital Charge Code	8003246
Hospital Revenue Code	279
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

PNEUMOTHORAX KIT ARW AK01500**

Facility

$234.00

Hospital Charge Code	8003246
Hospital Revenue Code	279
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.42
Rate for Payer: Oxford Commercial	$117.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$117.00

PNEUMOTHORAX WITH CC

Facility

$43,730.22

Service Code	MSDRG 200
Min. Negotiated Rate	$11,996.20
Max. Negotiated Rate	$43,730.22
Rate for Payer: Aetna Commercial	$37,068.26
Rate for Payer: Aetna Medicare Advantage	$11,996.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29,772.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29,772.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,576.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29,772.36
Rate for Payer: Cigna Commercial	$23,658.04
Rate for Payer: Cigna Medicare Advantage	$14,576.74
Rate for Payer: Clover Medicare Advantage	$13,847.90
Rate for Payer: EmblemHealth Commercial	$43,730.22
Rate for Payer: Humana Medicare Advantage	$15,014.04
Rate for Payer: Oxford Commercial	$14,785.58
Rate for Payer: UnitedHealthcare Commercial	$16,783.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,576.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15,451.34
Rate for Payer: Wellcare Medicare Advantage	$14,576.74

PNEUMOTHORAX WITH MCC

Facility

$63,026.52

Service Code	MSDRG 199
Min. Negotiated Rate	$19,250.89
Max. Negotiated Rate	$63,026.52
Rate for Payer: Aetna Commercial	$59,485.25
Rate for Payer: Aetna Medicare Advantage	$19,250.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48,793.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48,793.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,008.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48,793.59
Rate for Payer: Cigna Commercial	$37,965.20
Rate for Payer: Cigna Medicare Advantage	$21,008.84
Rate for Payer: Clover Medicare Advantage	$19,958.40
Rate for Payer: EmblemHealth Commercial	$63,026.52
Rate for Payer: Humana Medicare Advantage	$21,639.11
Rate for Payer: Oxford Commercial	$23,727.15
Rate for Payer: UnitedHealthcare Commercial	$26,932.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,008.84
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22,269.37
Rate for Payer: Wellcare Medicare Advantage	$21,008.84

PNEUMOTHORAX WITHOUT CC/MCC

Facility

$32,578.53

Service Code	MSDRG 201
Min. Negotiated Rate	$7,803.59
Max. Negotiated Rate	$32,578.53
Rate for Payer: Aetna Commercial	$24,113.09
Rate for Payer: Aetna Medicare Advantage	$7,803.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,572.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,572.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,859.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,572.57
Rate for Payer: Cigna Commercial	$15,389.67
Rate for Payer: Cigna Medicare Advantage	$10,859.51
Rate for Payer: Clover Medicare Advantage	$10,316.53
Rate for Payer: EmblemHealth Commercial	$32,578.53
Rate for Payer: Humana Medicare Advantage	$11,185.30
Rate for Payer: Oxford Commercial	$9,618.09
Rate for Payer: UnitedHealthcare Commercial	$10,917.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,859.51
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,511.08
Rate for Payer: Wellcare Medicare Advantage	$10,859.51

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	74110058
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$10,346.00
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,483.27
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	5100629
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$10,346.00
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,483.27
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	5100629
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	74110058
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	74110057
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Aetna Commercial	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,483.27
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	5100625
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	74110057
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	5100625
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$10,346.00
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,483.27
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA SINGLE

Facility

$34,486.68

Hospital Charge Code	74110056
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA SINGLE

Facility

$34,486.68

Hospital Charge Code	5100621
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$10,346.00
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,483.27
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

Know your out-of-pocket cost for care.

All Charges