Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-DRAINAGE SUBDIAPH OR SUBPHR

Facility

$6,420.00

Service Code	HCPCS 49406
Hospital Charge Code	7411586
Hospital Revenue Code	361
Min. Negotiated Rate	$963.00
Max. Negotiated Rate	$963.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.00

IR-DRAIN APPEND ABSC OPEN

Facility

$4,812.00

Service Code	HCPCS 44900
Hospital Charge Code	7411551
Hospital Revenue Code	361
Min. Negotiated Rate	$625.56
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$1,443.60
Rate for Payer: Aetna Medicare Advantage	$1,443.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,227.06
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	$1,227.06
Rate for Payer: Cigna Commercial	$813.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.56
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$721.80
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR-DRAIN APPEND ABSC OPEN

Facility

$4,812.00

Service Code	HCPCS 44900
Hospital Charge Code	2690125
Hospital Revenue Code	361
Min. Negotiated Rate	$721.80
Max. Negotiated Rate	$721.80
Rate for Payer: Qualcare PPO/HMO/WC	$721.80

IR-DRAIN APPEND ABSC OPEN

Facility

$4,812.00

Service Code	HCPCS 44900
Hospital Charge Code	2690125
Hospital Revenue Code	361
Min. Negotiated Rate	$625.56
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$1,443.60
Rate for Payer: Aetna Medicare Advantage	$1,443.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,227.06
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	$1,227.06
Rate for Payer: Cigna Commercial	$813.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.56
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$721.80
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR-DRAIN APPEND ABSC OPEN

Facility

$4,812.00

Service Code	HCPCS 44900
Hospital Charge Code	7411551
Hospital Revenue Code	361
Min. Negotiated Rate	$721.80
Max. Negotiated Rate	$721.80
Rate for Payer: Qualcare PPO/HMO/WC	$721.80

IR-DRAIN BLADDER ABSCESS

Facility

$3,129.00

Service Code	HCPCS 51080
Hospital Charge Code	7411621
Hospital Revenue Code	361
Min. Negotiated Rate	$469.35
Max. Negotiated Rate	$469.35
Rate for Payer: Qualcare PPO/HMO/WC	$469.35

IR-DRAIN BLADDER ABSCESS

Facility

$3,129.00

Service Code	HCPCS 51080
Hospital Charge Code	2690180
Hospital Revenue Code	361
Min. Negotiated Rate	$469.35
Max. Negotiated Rate	$469.35
Rate for Payer: Qualcare PPO/HMO/WC	$469.35

IR-DRAIN BLADDER ABSCESS

Facility

$3,129.00

Service Code	HCPCS 51080
Hospital Charge Code	2690180
Hospital Revenue Code	361
Min. Negotiated Rate	$406.77
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$938.70
Rate for Payer: Aetna Medicare Advantage	$938.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$797.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$797.89
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	$797.89
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.77
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$469.35
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR-DRAIN BLADDER ABSCESS

Facility

$3,129.00

Service Code	HCPCS 51080
Hospital Charge Code	7411621
Hospital Revenue Code	361
Min. Negotiated Rate	$406.77
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$938.70
Rate for Payer: Aetna Medicare Advantage	$938.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$797.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$797.89
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	$797.89
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.77
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$469.35
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR-DRAIN FING ABSESS-COMP

Facility

$3,801.00

Service Code	HCPCS 26011
Hospital Charge Code	2690030
Hospital Revenue Code	761
Min. Negotiated Rate	$100.59
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,140.30
Rate for Payer: Aetna Medicare Advantage	$1,140.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$969.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$969.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$969.25
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$494.13
Rate for Payer: Oxford Commercial	$1,900.50
Rate for Payer: Qualcare PPO/HMO/WC	$570.15
Rate for Payer: UnitedHealthcare Commercial	$1,900.50

IR-DRAIN FING ABSESS-COMP

Facility

$3,801.00

Service Code	HCPCS 26011
Hospital Charge Code	7411366
Hospital Revenue Code	761
Min. Negotiated Rate	$570.15
Max. Negotiated Rate	$570.15
Rate for Payer: Qualcare PPO/HMO/WC	$570.15

IR-DRAIN FING ABSESS-COMP

Facility

$3,801.00

Service Code	HCPCS 26011
Hospital Charge Code	2690030
Hospital Revenue Code	761
Min. Negotiated Rate	$570.15
Max. Negotiated Rate	$570.15
Rate for Payer: Qualcare PPO/HMO/WC	$570.15

IR-DRAIN FING ABSESS-COMP

Facility

$3,801.00

Service Code	HCPCS 26011
Hospital Charge Code	7411366
Hospital Revenue Code	761
Min. Negotiated Rate	$100.59
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,140.30
Rate for Payer: Aetna Medicare Advantage	$1,140.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$969.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$969.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$969.25
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$494.13
Rate for Payer: Oxford Commercial	$1,900.50
Rate for Payer: Qualcare PPO/HMO/WC	$570.15
Rate for Payer: UnitedHealthcare Commercial	$1,900.50

IR-DRAIN FING ABSESS-SIMP

Facility

$530.00

Service Code	HCPCS 26010
Hospital Charge Code	2690025
Hospital Revenue Code	361
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$79.50
Rate for Payer: Qualcare PPO/HMO/WC	$79.50

IR-DRAIN FING ABSESS-SIMP

Facility

$530.00

Service Code	HCPCS 26010
Hospital Charge Code	2690025
Hospital Revenue Code	361
Min. Negotiated Rate	$68.90
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$159.00
Rate for Payer: Aetna Medicare Advantage	$159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.15
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	$135.15
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.50
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-DRAIN FING ABSESS-SIMP

Facility

$530.00

Service Code	HCPCS 26010
Hospital Charge Code	7411365
Hospital Revenue Code	361
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$79.50
Rate for Payer: Qualcare PPO/HMO/WC	$79.50

IR-DRAIN FING ABSESS-SIMP

Facility

$530.00

Service Code	HCPCS 26010
Hospital Charge Code	7411365
Hospital Revenue Code	361
Min. Negotiated Rate	$68.90
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$159.00
Rate for Payer: Aetna Medicare Advantage	$159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.15
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	$135.15
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.50
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-DRAIN OF BREAST LES-BI

Facility

$5,305.00

Service Code	HCPCS 1900050
Hospital Charge Code	7411770
Hospital Revenue Code	361
Min. Negotiated Rate	$795.75
Max. Negotiated Rate	$795.75
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

IR-DRAIN OF BREAST LES-BI

Facility

$5,305.00

Service Code	HCPCS 1900050
Hospital Charge Code	2690300
Hospital Revenue Code	361
Min. Negotiated Rate	$795.75
Max. Negotiated Rate	$795.75
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

IR-DRAIN OF BREAST LES-BI

Facility

$5,305.00

Service Code	HCPCS 1900050
Hospital Charge Code	2690300
Hospital Revenue Code	361
Min. Negotiated Rate	$689.65
Max. Negotiated Rate	$2,652.50
Rate for Payer: Aetna Commercial	$1,591.50
Rate for Payer: Aetna Medicare Advantage	$1,591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,352.78
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	$1,352.78
Rate for Payer: Cigna Commercial	$2,652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.65
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

IR-DRAIN OF BREAST LES-BI

Facility

$5,305.00

Service Code	HCPCS 1900050
Hospital Charge Code	7411770
Hospital Revenue Code	361
Min. Negotiated Rate	$689.65
Max. Negotiated Rate	$2,652.50
Rate for Payer: Aetna Commercial	$1,591.50
Rate for Payer: Aetna Medicare Advantage	$1,591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,352.78
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	$1,352.78
Rate for Payer: Cigna Commercial	$2,652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.65
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

IR-DRAIN OF BREAST LES-LT

Facility

$3,392.55

Service Code	HCPCS 19000LT
Hospital Charge Code	321019000L
Hospital Revenue Code	361
Min. Negotiated Rate	$441.03
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,017.76
Rate for Payer: Aetna Medicare Advantage	$1,017.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$865.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$865.10
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	$865.10
Rate for Payer: Cigna Commercial	$1,696.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.03
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR-DRAIN OF BREAST LES-LT

Facility

$5,305.00

Service Code	HCPCS 19000LT
Hospital Charge Code	7411859
Hospital Revenue Code	361
Min. Negotiated Rate	$795.75
Max. Negotiated Rate	$795.75
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

IR-DRAIN OF BREAST LES-LT

Facility

$3,392.55

Service Code	HCPCS 19000LT
Hospital Charge Code	2690870
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR-DRAIN OF BREAST LES-LT

Facility

$5,305.00

Service Code	HCPCS 19000LT
Hospital Charge Code	7411859
Hospital Revenue Code	361
Min. Negotiated Rate	$689.65
Max. Negotiated Rate	$2,652.50
Rate for Payer: Aetna Commercial	$1,591.50
Rate for Payer: Aetna Medicare Advantage	$1,591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,352.78
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	$1,352.78
Rate for Payer: Cigna Commercial	$2,652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.65
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

Know your out-of-pocket cost for care.

All Charges