Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSG 1-3

Facility

$4,688.00

Service Code	HCPCS 95808
Hospital Charge Code	90000030
Hospital Revenue Code	920
Min. Negotiated Rate	$281.75
Max. Negotiated Rate	$11,682.00
Rate for Payer: Aetna Commercial	$1,406.40
Rate for Payer: Aetna Medicare Advantage	$1,406.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,195.44
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$609.44
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$703.20
Rate for Payer: UnitedHealthcare Commercial	$11,682.00

PSG STUDY 4 OR MORE

Facility

$40,000.00

Service Code	HCPCS 95810
Hospital Charge Code	90000035
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PSG STUDY 4 OR MORE

Facility

$40,000.00

Service Code	HCPCS 95810
Hospital Charge Code	90000035
Hospital Revenue Code	920
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,682.00

PSG W/CPAP OR BIPAP

Facility

$40,000.00

Service Code	HCPCS 95811
Hospital Charge Code	90000040
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PSG W/CPAP OR BIPAP

Facility

$40,000.00

Service Code	HCPCS 95811
Hospital Charge Code	90000040
Hospital Revenue Code	920
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,682.00

PSITTACOSIS AB

Facility

$100.85

Service Code	HCPCS 86171
Hospital Charge Code	3006863
Hospital Revenue Code	302
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

PSITTACOSIS AB

Facility

$100.85

Service Code	HCPCS 86171
Hospital Charge Code	3006863
Hospital Revenue Code	302
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.43
Rate for Payer: Aetna Medicare Advantage	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.68
Rate for Payer: Cigna Commercial	$10.01
Rate for Payer: Cigna Medicare Advantage	$5.00
Rate for Payer: Clover Medicare Advantage	$9.51
Rate for Payer: EmblemHealth Commercial	$30.03
Rate for Payer: Humana Medicare Advantage	$10.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.61
Rate for Payer: Wellcare Medicare Advantage	$10.01

PSN ALL POLY PAT PLY 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689982
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689982
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681302
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681302
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689623
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689623
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ASFB CPS 12MM VE L 6-9CD

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270700205
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

PSN ASFB CPS 12MM VE L 6-9CD

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270700205
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$1,854.00
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

PSN ASF CPS 10 MM VE L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692693
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10 MM VE L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692693
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MM VEL 10-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693241
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MM VEL 10-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693241
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MMVE L-6 9CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691312
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MMVE L-6 9CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691312
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MM VE L 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686961
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MM VE L 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686961
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MM VE L 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686935
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MM VE L 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686935
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

Know your out-of-pocket cost for care.

All Charges