Heights University Hospital

All Charges

Charge

Type

Setting

Price

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349
Hospital Revenue Code	272
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$13.11
Rate for Payer: Cigna Medicare Advantage	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$51.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$51.50

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349S
Hospital Revenue Code	272
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$13.11
Rate for Payer: Cigna Medicare Advantage	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$51.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$51.50

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$100.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349N
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Hospital Charge Code	270658349R
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$100.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349N
Hospital Revenue Code	272
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$13.11
Rate for Payer: Cigna Medicare Advantage	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Hospital Charge Code	270658349R
Hospital Revenue Code	272
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$51.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$51.50

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349S
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGEBAGW/JACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001456
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

DRAINAGEBAGW/JACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001456
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGEBAGWJACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001459
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGEBAGWJACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001459
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

DRAINAGE DEPOT LEG BAG 20/BX

Facility

$48.75

Hospital Charge Code	2709001460
Hospital Revenue Code	272
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$7.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

DRAINAGE DEPOT LEG BAG 20/BX

Facility

$48.75

Hospital Charge Code	2709001460
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$14.62
Rate for Payer: Aetna Medicare Advantage	$14.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Commercial	$24.38

DRAINAGE LYMPH NODE LESION

Facility

$16,852.60

Service Code	HCPCS 38305
Hospital Charge Code	1600000650
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$5,055.78
Rate for Payer: Aetna Medicare Advantage	$5,055.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,297.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,297.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,297.41
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,190.84
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,527.89
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DRAINAGE LYMPH NODE LESION

Facility

$16,852.60

Service Code	HCPCS 38305
Hospital Charge Code	1600000650
Hospital Revenue Code	360
Min. Negotiated Rate	$2,527.89
Max. Negotiated Rate	$2,527.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,527.89

DRAINAGE OF HIP AND JOINT

Facility

$11,558.00

Service Code	HCPCS 27030
Hospital Charge Code	1600000332
Hospital Revenue Code	360
Min. Negotiated Rate	$1,502.54
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$3,467.40
Rate for Payer: Aetna Medicare Advantage	$3,467.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,947.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,947.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,947.29
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,502.54
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,733.70
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

DRAINAGE OF HIP AND JOINT

Facility

$11,558.00

Service Code	HCPCS 27030
Hospital Charge Code	1600000332
Hospital Revenue Code	360
Min. Negotiated Rate	$1,733.70
Max. Negotiated Rate	$1,733.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,733.70

DRAINAGE OF NOSE LESION

Facility

$714.00

Service Code	HCPCS 30000
Hospital Charge Code	16000923
Hospital Revenue Code	360
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$107.10

DRAINAGE OF NOSE LESION

Facility

$714.00

Service Code	HCPCS 30000
Hospital Charge Code	16000923
Hospital Revenue Code	360
Min. Negotiated Rate	$92.82
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Aetna Medicare Advantage	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.07
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.82
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.10
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DRAINAGE OF SCROTAL WALL ABSCE

Facility

$6,799.08

Service Code	HCPCS 55100
Hospital Charge Code	160000233
Hospital Revenue Code	360
Min. Negotiated Rate	$883.88
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,039.72
Rate for Payer: Aetna Medicare Advantage	$2,039.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,733.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,733.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,733.77
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

DRAINAGE OF SCROTAL WALL ABSCE

Facility

$6,799.08

Service Code	HCPCS 55100
Hospital Charge Code	160000233
Hospital Revenue Code	360
Min. Negotiated Rate	$1,019.86
Max. Negotiated Rate	$1,019.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86

DRAINAGE OF SCROTUM

Facility

$6,782.72

Service Code	HCPCS 54700
Hospital Charge Code	16000650
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.41
Max. Negotiated Rate	$1,017.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41

DRAINAGE OF SCROTUM

Facility

$6,782.72

Service Code	HCPCS 54700
Hospital Charge Code	16000650
Hospital Revenue Code	360
Min. Negotiated Rate	$881.75
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,034.82
Rate for Payer: Aetna Medicare Advantage	$2,034.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,729.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,729.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,729.59
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$881.75
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DRAINAGE PAROTID ABSCESS COMPL

Facility

$7,090.00

Service Code	HCPCS 42305
Hospital Charge Code	5780220
Hospital Revenue Code	450
Min. Negotiated Rate	$1,063.50
Max. Negotiated Rate	$1,063.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.50

DRAINAGE PAROTID ABSCESS COMPL

Facility

$7,090.00

Service Code	HCPCS 42305
Hospital Charge Code	5780220
Hospital Revenue Code	450
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$2,127.00
Rate for Payer: Aetna Medicare Advantage	$2,127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,807.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,807.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,807.95
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$921.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.50

Know your out-of-pocket cost for care.

All Charges