Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPIROMETER INCENTIVE DEVICE***

Facility

$25.00

Hospital Charge Code	9501024
Hospital Revenue Code	279
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

SPIROMETER INCENTIVE VOLUMETRC

Facility

$12.89

Hospital Charge Code	270200070
Hospital Revenue Code	270
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

SPIROMETER INCENTIVE VOLUMETRC

Facility

$12.89

Hospital Charge Code	270200070
Hospital Revenue Code	270
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$6.45
Rate for Payer: Aetna Commercial	$3.87
Rate for Payer: Aetna Medicare Advantage	$3.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.29
Rate for Payer: Cigna Commercial	$6.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.68
Rate for Payer: Oxford Commercial	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$6.45

SPIROMETRY PRE AND POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	83652375
Hospital Revenue Code	460
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

SPIROMETRY PRE AND POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	83652375
Hospital Revenue Code	460
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.22
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

SPIROMETRY PRE & POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502875
Hospital Revenue Code	460
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

SPIROMETRY PRE & POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502875
Hospital Revenue Code	460
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.22
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

SPIROMETRY PRE&POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502730
Hospital Revenue Code	460
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.22
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

SPIROMETRY PRE&POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502730
Hospital Revenue Code	460
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

SPIROMETRY SIMPLE THERAPHY***

Facility

$201.30

Service Code	HCPCS 94010
Hospital Charge Code	9500570
Hospital Revenue Code	419
Min. Negotiated Rate	$30.20
Max. Negotiated Rate	$30.20
Rate for Payer: Qualcare PPO/HMO/WC	$30.20

SPIROMETRY SIMPLE THERAPHY***

Facility

$201.30

Service Code	HCPCS 94010
Hospital Charge Code	9500570
Hospital Revenue Code	419
Min. Negotiated Rate	$26.17
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.33
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.17
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.20
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

SPIROMETRY W GRAPHIC REC(MACHI

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	83652373
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIROMETRY W GRAPHIC REC(MACHI

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	83652373
Hospital Revenue Code	460
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: Aetna Medicare Advantage	$106.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.27
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.02
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

SPIROMTRY W/DILATOR UP TO 2 YR

Facility

$464.65

Service Code	HCPCS 94012
Hospital Charge Code	9501292
Hospital Revenue Code	460
Min. Negotiated Rate	$60.40
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$139.40
Rate for Payer: Aetna Medicare Advantage	$139.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.49
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.70
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

SPIROMTRY W/DILATOR UP TO 2 YR

Facility

$464.65

Service Code	HCPCS 94012
Hospital Charge Code	9501292
Hospital Revenue Code	460
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$69.70
Rate for Payer: Qualcare PPO/HMO/WC	$69.70

SPIRONOLACTONE 12.5MG TAB

Facility

$2.00

Hospital Charge Code	60635653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

SPIRONOLACTONE 12.5MG TAB

Facility

$2.00

Hospital Charge Code	60635653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

SPIRONOLACTONE 25 MG TAB

Facility

$4.00

Service Code	NDC 51079010320
Hospital Charge Code	60627976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SPIRONOLACTONE 25 MG TAB

Facility

$4.00

Service Code	NDC 51079010320
Hospital Charge Code	60627976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SPIRONOLACTONE (ALDACTONE) 50M

Facility

$5.76

Service Code	NDC 68084020701
Hospital Charge Code	60630142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$2.88

SPIRONOLACTONE (ALDACTONE) 50M

Facility

$5.76

Service Code	NDC 68084020701
Hospital Charge Code	60630142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

SPIRONOLACTONE HCTZ/25/25MG

Facility

$2.45

Hospital Charge Code	60628707
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

SPIRONOLACTONE HCTZ/25/25MG

Facility

$2.45

Hospital Charge Code	60628707
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SPIROTOMY W GRAPHIC REC (MACH)

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	87502725
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIROTOMY W GRAPHIC REC (MACH)

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	87502725
Hospital Revenue Code	460
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: Aetna Medicare Advantage	$106.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.27
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.02
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

Know your out-of-pocket cost for care.

All Charges