Heights University Hospital

All Charges

Charge

Type

Setting

Price

PULSE OXIMETRY NON INV CONT MO

Facility

$1,066.25

Service Code	HCPCS 94762
Hospital Charge Code	9500614
Hospital Revenue Code	460
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$319.88
Rate for Payer: Aetna Medicare Advantage	$319.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.89
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.61
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.94
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PULSE OXIMETRY NON INV CONT MO

Facility

$1,066.25

Service Code	HCPCS 94762
Hospital Charge Code	9500614
Hospital Revenue Code	460
Min. Negotiated Rate	$159.94
Max. Negotiated Rate	$159.94
Rate for Payer: Qualcare PPO/HMO/WC	$159.94

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83092032
Hospital Revenue Code	460
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83092032
Hospital Revenue Code	460
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$150.90
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.39
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83091022
Hospital Revenue Code	460
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$150.90
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.39
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PULSE OXIMETRY SINGLE

Facility

$503.00

Hospital Charge Code	83091022
Hospital Revenue Code	460
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

PULSE OXIMETRY SPOT CHECK

Facility

$10,110.97

Service Code	HCPCS 94760
Hospital Charge Code	9500612
Hospital Revenue Code	460
Min. Negotiated Rate	$1,516.65
Max. Negotiated Rate	$1,516.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,516.65

PULSE OXIMETRY SPOT CHECK

Facility

$10,110.97

Service Code	HCPCS 94760
Hospital Charge Code	9500612
Hospital Revenue Code	460
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$3,033.29
Rate for Payer: Aetna Commercial	$3,033.29
Rate for Payer: Aetna Medicare Advantage	$3,033.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,578.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,578.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,578.30
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.43
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,516.65
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PULSE OX MULTI DETERMINATION

Facility

$10,222.71

Service Code	HCPCS 94761
Hospital Charge Code	9500615
Hospital Revenue Code	460
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$3,066.81
Rate for Payer: Aetna Commercial	$3,066.81
Rate for Payer: Aetna Medicare Advantage	$3,066.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,606.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,606.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,606.79
Rate for Payer: Cigna Commercial	$5.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.95
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.41
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PULSE OX MULTI DETERMINATION

Facility

$10,222.71

Service Code	HCPCS 94761
Hospital Charge Code	9500615
Hospital Revenue Code	460
Min. Negotiated Rate	$1,533.41
Max. Negotiated Rate	$1,533.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.41

PULSE SPRAY INFUSION SYS 5FR 4

Facility

$2,260.00

Hospital Charge Code	270665488
Hospital Revenue Code	270
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$339.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00

PULSE SPRAY INFUSION SYS 5FR 4

Facility

$2,260.00

Hospital Charge Code	270665488
Hospital Revenue Code	270
Min. Negotiated Rate	$293.80
Max. Negotiated Rate	$1,130.00
Rate for Payer: Aetna Commercial	$678.00
Rate for Payer: Aetna Medicare Advantage	$678.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.30
Rate for Payer: Cigna Commercial	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.80
Rate for Payer: Oxford Commercial	$1,130.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00
Rate for Payer: UnitedHealthcare Commercial	$1,130.00

PULSE SPRAY INFUSION SYS 5FR 9

Facility

$2,260.00

Hospital Charge Code	270663789
Hospital Revenue Code	270
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$339.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00

PULSE SPRAY INFUSION SYS 5FR 9

Facility

$2,260.00

Hospital Charge Code	270663789
Hospital Revenue Code	270
Min. Negotiated Rate	$293.80
Max. Negotiated Rate	$1,130.00
Rate for Payer: Aetna Commercial	$678.00
Rate for Payer: Aetna Medicare Advantage	$678.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.30
Rate for Payer: Cigna Commercial	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.80
Rate for Payer: Oxford Commercial	$1,130.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.00
Rate for Payer: UnitedHealthcare Commercial	$1,130.00

PULSEVAC FAN SPRAY TIP *****

Facility

$40.00

Hospital Charge Code	1606276
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

PULSEVAC FAN SPRAY TIP *****

Facility

$40.00

Hospital Charge Code	1606276
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

PUMP ABBOTT ADMIN SET***

Facility

$42.00

Hospital Charge Code	7000458
Hospital Revenue Code	279
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

PUMP ABBOTT ADMIN SET***

Facility

$42.00

Hospital Charge Code	7000458
Hospital Revenue Code	279
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$21.00

PUMP AMPRO SUMP AN-40

Facility

$508.00

Hospital Charge Code	270301380
Hospital Revenue Code	272
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$76.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.20

PUMP AMPRO SUMP AN-40

Facility

$508.00

Hospital Charge Code	270301380
Hospital Revenue Code	272
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$254.00
Rate for Payer: Aetna Commercial	$152.40
Rate for Payer: Aetna Medicare Advantage	$152.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.54
Rate for Payer: Cigna Commercial	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.04
Rate for Payer: Oxford Commercial	$254.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.20
Rate for Payer: UnitedHealthcare Commercial	$254.00

PUMP BREAST ******

Facility

$23.00

Hospital Charge Code	8003071
Hospital Revenue Code	279
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

PUMP BREAST ******

Facility

$23.00

Hospital Charge Code	8003071
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PUMP BREAST *******

Facility

$32.00

Hospital Charge Code	1800283
Hospital Revenue Code	279
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

PUMP BREAST *******

Facility

$32.00

Hospital Charge Code	1800283
Hospital Revenue Code	279
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

PUMP BREAST *********

Facility

$40.00

Hospital Charge Code	1801133
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

Know your out-of-pocket cost for care.

All Charges