Heights University Hospital

All Charges

Charge

Type

Setting

Price

PEEL-AWAY INTRODUCER 5FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0102
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PEEL-AWAY INTRODUCER 6FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0103
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PEEL-AWAY INTRODUCER 6FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0103
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

PEEL-AWAY INTRODUCER 8FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0104
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PEEL-AWAY INTRODUCER 8FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0104
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

PEEL-AWAY INTRODUCER 9FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0105
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PEEL-AWAY INTRODUCER 9FR 15.5

Facility

$250.00

Hospital Charge Code	270CH0105
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

PEEL AWAY SHEATH SET 12FR.

Facility

$241.00

Hospital Charge Code	270330508
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$58.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.32
Rate for Payer: Qualcare PPO/HMO/WC	$36.15

PEEL AWAY SHEATH SET 12FR.

Facility

$241.00

Hospital Charge Code	270330508
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$120.50
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna Medicare Advantage	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.45
Rate for Payer: Cigna Commercial	$120.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.32
Rate for Payer: Qualcare PPO/HMO/WC	$36.15

PEG 2.7MM X 20MM LOCKING

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664186
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEG 2.7MM X 20MM LOCKING

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664186
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEGANONE (ETHOTOIN)

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3009792
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

PEGANONE (ETHOTOIN)

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3009792
Hospital Revenue Code	301
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

PEG DRIVER 2.0mm FAST

Facility

$275.00

Hospital Charge Code	270638005
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PEG DRIVER 2.0mm FAST

Facility

$275.00

Hospital Charge Code	270638005
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PEG-ELECTROLYTE LAVAGE SOLN

Facility

$136.85

Hospital Charge Code	60628135
Hospital Revenue Code	250
Min. Negotiated Rate	$17.79
Max. Negotiated Rate	$68.42
Rate for Payer: Aetna Commercial	$41.05
Rate for Payer: Aetna Medicare Advantage	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.90
Rate for Payer: Cigna Commercial	$68.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.79
Rate for Payer: Oxford Commercial	$68.42
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$68.42

PEG-ELECTROLYTE LAVAGE SOLN

Facility

$136.85

Hospital Charge Code	60628135
Hospital Revenue Code	250
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

PEGFILGRASTIM 6 MG/0.6 ML INJ

Facility

$26,692.93

Service Code	HCPCS J2505
Hospital Charge Code	60629301
Hospital Revenue Code	636
Min. Negotiated Rate	$4,003.94
Max. Negotiated Rate	$13,346.47
Rate for Payer: Aetna Commercial	$8,007.88
Rate for Payer: Aetna Medicare Advantage	$8,007.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,806.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,806.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,806.70
Rate for Payer: Cigna Commercial	$13,346.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,459.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,003.94

PEGFILGRASTIM 6 MG/0.6 ML INJ

Facility

$26,692.93

Service Code	HCPCS J2505
Hospital Charge Code	60629301
Hospital Revenue Code	636
Min. Negotiated Rate	$4,003.94
Max. Negotiated Rate	$6,459.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,459.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,003.94

PEGFILGRASTIM-JMDB 6MG/0.6ML

Facility

$26,539.57

Service Code	HCPCS Q5108
Hospital Charge Code	606390197
Hospital Revenue Code	636
Min. Negotiated Rate	$3,980.94
Max. Negotiated Rate	$7,961.87
Rate for Payer: Aetna Commercial	$7,961.87
Rate for Payer: Aetna Medicare Advantage	$7,961.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,767.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,767.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,767.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,422.58
Rate for Payer: Qualcare PPO/HMO/WC	$3,980.94

PEGFILGRASTIM-JMDB 6MG/0.6ML

Facility

$26,539.57

Service Code	HCPCS Q5108
Hospital Charge Code	606390197
Hospital Revenue Code	636
Min. Negotiated Rate	$3,980.94
Max. Negotiated Rate	$6,422.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,422.58
Rate for Payer: Qualcare PPO/HMO/WC	$3,980.94

PEG, FLTD LCKNG 2.3X20MM TI

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686701
Hospital Revenue Code	278
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$285.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.35
Rate for Payer: Cigna Commercial	$285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.94
Rate for Payer: Qualcare PPO/HMO/WC	$85.50

PEG, FLTD LCKNG 2.3X20MM TI

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686701
Hospital Revenue Code	278
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$137.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.94
Rate for Payer: Qualcare PPO/HMO/WC	$85.50

PEG FULLY THRD 2.5x20mm FP-20

Facility

$347.25

Hospital Charge Code	270635664
Hospital Revenue Code	272
Min. Negotiated Rate	$45.14
Max. Negotiated Rate	$173.62
Rate for Payer: Aetna Commercial	$104.17
Rate for Payer: Aetna Medicare Advantage	$104.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.55
Rate for Payer: Cigna Commercial	$173.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.14
Rate for Payer: Oxford Commercial	$173.62
Rate for Payer: Qualcare PPO/HMO/WC	$52.09
Rate for Payer: UnitedHealthcare Commercial	$173.62

PEG FULLY THRD 2.5x20mm FP-20

Facility

$347.25

Hospital Charge Code	270635664
Hospital Revenue Code	272
Min. Negotiated Rate	$52.09
Max. Negotiated Rate	$52.09
Rate for Payer: Qualcare PPO/HMO/WC	$52.09

Know your out-of-pocket cost for care.

All Charges