Heights University Hospital

All Charges

Charge

Type

Setting

Price

DRAIN/INJ MAJOR JNT W US

Facility

$1,449.20

Service Code	HCPCS 20611
Hospital Charge Code	321020611
Hospital Revenue Code	361
Min. Negotiated Rate	$188.40
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$434.76
Rate for Payer: Aetna Medicare Advantage	$434.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.55
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	$369.55
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.38
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DRAIN/INJ MAJOR JNT W US

Facility

$1,253.85

Service Code	HCPCS 20611
Hospital Charge Code	7411347
Hospital Revenue Code	361
Min. Negotiated Rate	$188.08
Max. Negotiated Rate	$188.08
Rate for Payer: Qualcare PPO/HMO/WC	$188.08

DRAIN INTRAORAL SUBMAX/SUBLING

Facility

$1,453.00

Service Code	HCPCS 42310
Hospital Charge Code	5780225
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

DRAIN INTRAORAL SUBMAX/SUBLING

Facility

$1,453.00

Service Code	HCPCS 42310
Hospital Charge Code	5780225
Hospital Revenue Code	450
Min. Negotiated Rate	$58.44
Max. Negotiated Rate	$1,284.36
Rate for Payer: Aetna Commercial	$435.90
Rate for Payer: Aetna Medicare Advantage	$435.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.51
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.89
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

DRAIN JACKSON-PRT 15/FR W/TROC

Facility

$59.00

Hospital Charge Code	270655679
Hospital Revenue Code	271
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

DRAIN JACKSON-PRT 15/FR W/TROC

Facility

$59.00

Hospital Charge Code	270655679
Hospital Revenue Code	271
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Oxford Commercial	$29.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$29.50

DRAIN J P****

Facility

$145.00

Hospital Charge Code	1800168
Hospital Revenue Code	279
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

DRAIN J P****

Facility

$145.00

Hospital Charge Code	1800168
Hospital Revenue Code	279
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.85
Rate for Payer: Oxford Commercial	$72.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$72.50

DRAIN J P 7MM FLAT

Facility

$22.95

Hospital Charge Code	270600249
Hospital Revenue Code	270
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$11.47
Rate for Payer: Aetna Commercial	$6.88
Rate for Payer: Aetna Medicare Advantage	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.85
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.98
Rate for Payer: Oxford Commercial	$11.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$11.47

DRAIN J P 7MM FLAT

Facility

$22.95

Hospital Charge Code	270600249
Hospital Revenue Code	270
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

DRAIN J P FLAT SUCTION *****

Facility

$103.00

Hospital Charge Code	1601228
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAIN J P FLAT SUCTION *****

Facility

$103.00

Hospital Charge Code	1601228
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

DRAIN J P KIT

Facility

$152.85

Hospital Charge Code	270060760
Hospital Revenue Code	272
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$76.42
Rate for Payer: Aetna Commercial	$45.85
Rate for Payer: Aetna Medicare Advantage	$45.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$76.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.87
Rate for Payer: Oxford Commercial	$76.42
Rate for Payer: Qualcare PPO/HMO/WC	$22.93
Rate for Payer: UnitedHealthcare Commercial	$76.42

DRAIN J P KIT

Facility

$152.85

Hospital Charge Code	270060760
Hospital Revenue Code	272
Min. Negotiated Rate	$22.93
Max. Negotiated Rate	$22.93
Rate for Payer: Qualcare PPO/HMO/WC	$22.93

DRAIN J P KIT 060760

Facility

$58.36

Hospital Charge Code	70060760
Hospital Revenue Code	272
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.75

DRAIN J P KIT 060760

Facility

$58.36

Hospital Charge Code	70060760
Hospital Revenue Code	272
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$29.18
Rate for Payer: Aetna Commercial	$17.51
Rate for Payer: Aetna Medicare Advantage	$17.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.88
Rate for Payer: Cigna Commercial	$29.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Oxford Commercial	$29.18
Rate for Payer: Qualcare PPO/HMO/WC	$8.75
Rate for Payer: UnitedHealthcare Commercial	$29.18

DRAIN J P RESER HEYER 100CC***

Facility

$25.00

Hospital Charge Code	8002453
Hospital Revenue Code	279
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

DRAIN J P RESER HEYER 100CC***

Facility

$25.00

Hospital Charge Code	8002453
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

DRAIN J P RESERVIOR

Facility

$27.91

Hospital Charge Code	270605540
Hospital Revenue Code	272
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$13.96
Rate for Payer: Aetna Commercial	$8.37
Rate for Payer: Aetna Medicare Advantage	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Oxford Commercial	$13.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$13.96

DRAIN J P RESERVIOR

Facility

$27.91

Hospital Charge Code	270605540
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

DRAIN MALECOT 22FR. FOUR-WING

Facility

$131.00

Hospital Charge Code	270331377
Hospital Revenue Code	272
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$65.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$65.50

DRAIN MALECOT 22FR. FOUR-WING

Facility

$131.00

Hospital Charge Code	270331377
Hospital Revenue Code	272
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

DRAIN NECK/CHEST LESION

Facility

$11,141.64

Service Code	HCPCS 21501
Hospital Charge Code	16000540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,671.25
Max. Negotiated Rate	$1,671.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25

DRAIN NECK/CHEST LESION

Facility

$11,141.64

Service Code	HCPCS 21501
Hospital Charge Code	16000540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,448.41
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$3,342.49
Rate for Payer: Aetna Medicare Advantage	$3,342.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,841.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,841.12
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	$2,841.12
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.41
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DRAIN OUTER EAR CANAL LESION

Facility

$3,005.56

Service Code	HCPCS 69020
Hospital Charge Code	16001045
Hospital Revenue Code	360
Min. Negotiated Rate	$450.83
Max. Negotiated Rate	$450.83
Rate for Payer: Qualcare PPO/HMO/WC	$450.83

Know your out-of-pocket cost for care.

All Charges