Heights University Hospital

All Charges

Charge

Type

Setting

Price

PEG HI COMPRESS LOCKING 2.7X16

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664355
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$156.00
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEG HI COMPRESS LOCKING 2.7X16

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664355
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEG HI COMPRESS LOCKING 2.7X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664356
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 HI COMPRESS LOCKING 2.7X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664356
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

PEG HIGH COMP LOCKING 2.7x22MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664393
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$156.00
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEG HIGH COMP LOCKING 2.7x22MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664393
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEG HIGH COMPRESSION 2.7 X 14

Facility

$495.00

Hospital Charge Code	270664390
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 HIGH COMPRESSION 2.7 X 14

Facility

$495.00

Hospital Charge Code	270664390
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

PEG HIGH COMPRESSION 2.7 X 21

Facility

$495.00

Hospital Charge Code	270664392
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

PEG HIGH COMPRESSION 2.7 X 21

Facility

$495.00

Hospital Charge Code	270664392
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 HIGH COMPRESSION 2.7X24

Facility

$495.00

Hospital Charge Code	270664395
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

PEG HIGH COMPRESSION 2.7X24

Facility

$495.00

Hospital Charge Code	270664395
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 HIGH COMPR LKG TI 2.7X23MM

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664394
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

PEG HIGH COMPR LKG TI 2.7X23MM

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664394
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 HIGH COMPR LOCKNG 2.7X19MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664391
Hospital Revenue Code	278
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$106.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

PEG HIGH COMPR LOCKNG 2.7X19MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664391
Hospital Revenue Code	278
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$132.60
Rate for Payer: Aetna Medicare Advantage	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.71
Rate for Payer: Cigna Commercial	$221.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

PEG KIT 20FR

Facility

$442.18

Hospital Charge Code	270690646
Hospital Revenue Code	272
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$221.09
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna Medicare Advantage	$132.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.48
Rate for Payer: Oxford Commercial	$221.09
Rate for Payer: Qualcare PPO/HMO/WC	$66.33
Rate for Payer: UnitedHealthcare Commercial	$221.09

PEG KIT 20FR

Facility

$442.18

Hospital Charge Code	270690646
Hospital Revenue Code	272
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

PEG KIT ENDOVIVE STD 24FR

Facility

$1,200.00

Hospital Charge Code	270693120
Hospital Revenue Code	272
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

PEG KIT ENDOVIVE STD 24FR

Facility

$1,200.00

Hospital Charge Code	270693120
Hospital Revenue Code	272
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Commercial	$600.00

PEG KIT MIC 24 FR

Facility

$448.45

Hospital Charge Code	270686527
Hospital Revenue Code	272
Min. Negotiated Rate	$67.27
Max. Negotiated Rate	$67.27
Rate for Payer: Qualcare PPO/HMO/WC	$67.27

PEG KIT MIC 24 FR

Facility

$448.45

Hospital Charge Code	270686527
Hospital Revenue Code	272
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$224.22
Rate for Payer: Aetna Commercial	$134.53
Rate for Payer: Aetna Medicare Advantage	$134.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.35
Rate for Payer: Cigna Commercial	$224.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.30
Rate for Payer: Oxford Commercial	$224.22
Rate for Payer: Qualcare PPO/HMO/WC	$67.27
Rate for Payer: UnitedHealthcare Commercial	$224.22

PEG LKG T8 2.0X18MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700516
Hospital Revenue Code	278
Min. Negotiated Rate	$186.34
Max. Negotiated Rate	$621.15
Rate for Payer: Aetna Commercial	$372.69
Rate for Payer: Aetna Medicare Advantage	$372.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.79
Rate for Payer: Cigna Commercial	$621.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.64
Rate for Payer: Qualcare PPO/HMO/WC	$186.34

PEG LKG T8 2.0X18MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700516
Hospital Revenue Code	278
Min. Negotiated Rate	$186.34
Max. Negotiated Rate	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.64
Rate for Payer: Qualcare PPO/HMO/WC	$186.34

PEG LOCKING 2.0MM X 20MM

Facility

$875.00

Hospital Charge Code	270667226
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75

Know your out-of-pocket cost for care.

All Charges