Heights University Hospital

All Charges

Charge

Type

Setting

Price

GASTRHPHY STR PERF DUOD/GASTC

Facility

$16,639.25

Service Code	HCPCS 43840
Hospital Charge Code	16000967
Hospital Revenue Code	360
Min. Negotiated Rate	$2,495.89
Max. Negotiated Rate	$2,495.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,495.89

GASTRHPHY STR PERF DUOD/GASTC

Facility

$16,639.25

Service Code	HCPCS 43840
Hospital Charge Code	16000967
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$9,181.40
Rate for Payer: Aetna Commercial	$4,991.77
Rate for Payer: Aetna Medicare Advantage	$4,991.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,243.01
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	$4,243.01
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,163.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,495.89
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

GASTRIC ANALYSIS*****

Facility

$81.00

Hospital Charge Code	8002271
Hospital Revenue Code	279
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$40.50

GASTRIC ANALYSIS*****

Facility

$81.00

Hospital Charge Code	8002271
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

GASTRIC BAND ADJ W/ DISSECTOR

Facility

$14,445.00

Hospital Charge Code	270641522
Hospital Revenue Code	272
Min. Negotiated Rate	$1,877.85
Max. Negotiated Rate	$7,222.50
Rate for Payer: Aetna Commercial	$4,333.50
Rate for Payer: Aetna Medicare Advantage	$4,333.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,683.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,683.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,683.47
Rate for Payer: Cigna Commercial	$7,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,877.85
Rate for Payer: Oxford Commercial	$7,222.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,166.75
Rate for Payer: UnitedHealthcare Commercial	$7,222.50

GASTRIC BAND ADJ W/ DISSECTOR

Facility

$14,445.00

Hospital Charge Code	270641522
Hospital Revenue Code	272
Min. Negotiated Rate	$2,166.75
Max. Negotiated Rate	$2,166.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,166.75

GASTRIC FUNDOPLICATION

Facility

$61,903.72

Service Code	APR-DRG 2324
Min. Negotiated Rate	$60,689.92
Max. Negotiated Rate	$61,903.72
Rate for Payer: Aetna Better Health Medicaid	$60,689.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$61,903.72

GASTRIC FUNDOPLICATION

Facility

$18,533.65

Service Code	APR-DRG 2322
Min. Negotiated Rate	$18,170.25
Max. Negotiated Rate	$18,533.65
Rate for Payer: Aetna Better Health Medicaid	$18,170.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,533.65

GASTRIC FUNDOPLICATION

Facility

$25,764.77

Service Code	APR-DRG 2323
Min. Negotiated Rate	$25,259.58
Max. Negotiated Rate	$25,764.77
Rate for Payer: Aetna Better Health Medicaid	$25,259.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,764.77

GASTRIC FUNDOPLICATION

Facility

$15,568.96

Service Code	APR-DRG 2321
Min. Negotiated Rate	$15,263.69
Max. Negotiated Rate	$15,568.96
Rate for Payer: Aetna Better Health Medicaid	$15,263.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,568.96

GASTRIC LAVAGE*******

Facility

$81.00

Hospital Charge Code	8002289
Hospital Revenue Code	279
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$40.50

GASTRIC LAVAGE*******

Facility

$81.00

Hospital Charge Code	8002289
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

GASTRIC LAVAGE/CLOSED SYSTEM**

Facility

$232.00

Hospital Charge Code	8003519
Hospital Revenue Code	279
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

GASTRIC LAVAGE/CLOSED SYSTEM**

Facility

$232.00

Hospital Charge Code	8003519
Hospital Revenue Code	279
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$116.00
Rate for Payer: Aetna Commercial	$69.60
Rate for Payer: Aetna Medicare Advantage	$69.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.16
Rate for Payer: Cigna Commercial	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Oxford Commercial	$116.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Commercial	$116.00

GASTRIC TUBE REPLACEMNT DEVICE

Facility

$290.00

Hospital Charge Code	270325686
Hospital Revenue Code	272
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$87.00
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$145.00

GASTRIC TUBE REPLACEMNT DEVICE

Facility

$290.00

Hospital Charge Code	270325686
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

GASTRIN

Facility

$622.00

Service Code	HCPCS 82941
Hospital Charge Code	38472293
Hospital Revenue Code	301
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.12
Rate for Payer: Aetna Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.60
Rate for Payer: Cigna Commercial	$17.63
Rate for Payer: Cigna Medicare Advantage	$8.81
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.69
Rate for Payer: Wellcare Medicare Advantage	$17.63

GASTRIN

Facility

$622.00

Service Code	HCPCS 82941
Hospital Charge Code	38472293
Hospital Revenue Code	301
Min. Negotiated Rate	$93.30
Max. Negotiated Rate	$93.30
Rate for Payer: Qualcare PPO/HMO/WC	$93.30

GASTRIN SERUM*****

Facility

$227.00

Service Code	HCPCS 82941
Hospital Charge Code	3009996
Hospital Revenue Code	301
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.12
Rate for Payer: Aetna Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.60
Rate for Payer: Cigna Commercial	$17.63
Rate for Payer: Cigna Medicare Advantage	$8.81
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.69
Rate for Payer: Wellcare Medicare Advantage	$17.63

GASTRIN SERUM*****

Facility

$227.00

Service Code	HCPCS 82941
Hospital Charge Code	3009996
Hospital Revenue Code	301
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

GASTRIN, SERUM

Facility

$181.65

Service Code	HCPCS 82941
Hospital Charge Code	3004256
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

GASTRIN, SERUM

Facility

$181.65

Service Code	HCPCS 82941
Hospital Charge Code	3004256
Hospital Revenue Code	301
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.12
Rate for Payer: Aetna Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.60
Rate for Payer: Cigna Commercial	$17.63
Rate for Payer: Cigna Medicare Advantage	$8.81
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.69
Rate for Payer: Wellcare Medicare Advantage	$17.63

GASTRIN,SERUM

Facility

$667.59

Service Code	HCPCS 82941
Hospital Charge Code	39900084
Hospital Revenue Code	301
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$17.63
Rate for Payer: Cigna Medicare Advantage	$8.81
Rate for Payer: Aetna Commercial	$57.12
Rate for Payer: Aetna Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.60
Rate for Payer: Clover Medicare Advantage	$16.75
Rate for Payer: EmblemHealth Commercial	$52.89
Rate for Payer: Humana Medicare Advantage	$18.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.69
Rate for Payer: Wellcare Medicare Advantage	$17.63

GASTRIN,SERUM

Facility

$667.59

Service Code	HCPCS 82941
Hospital Charge Code	39900084
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

GASTRODUODENOSTOMY WO VAGOTOMY

Facility

$112,126.91

Service Code	HCPCS 43850
Hospital Charge Code	1600186
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$56,063.46
Rate for Payer: Aetna Commercial	$33,638.07
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
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	$28,592.36
Rate for Payer: Cigna Commercial	$56,063.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,576.50
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

Know your out-of-pocket cost for care.

All Charges