Heights University Hospital

All Charges

Charge

Type

Setting

Price

PEG THREADED NL TI 2.7X24MM

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664418
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 THREADED NL TI 2.7X24MM

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664418
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 THREADED NON LOCK 2.7x18MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664416
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 THREADED NON LOCK 2.7x18MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664416
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 THRED FLUTD LCKNG 2.3X22MM

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686659
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 THRED FLUTD LCKNG 2.3X22MM

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686659
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 VARIAX LOCKING T8 2X20MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700619
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 VARIAX LOCKING T8 2X20MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700619
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

PELLET SALT-WATER SOFTENER

Facility

$4.00

Hospital Charge Code	270605607
Hospital Revenue Code	809
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

PELLET SALT-WATER SOFTENER

Facility

$4.00

Hospital Charge Code	270605607
Hospital Revenue Code	809
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PELLETS CALC SULF 20C CSP2006S

Facility

$3,348.00

Hospital Charge Code	270628180
Hospital Revenue Code	272
Min. Negotiated Rate	$502.20
Max. Negotiated Rate	$502.20
Rate for Payer: Qualcare PPO/HMO/WC	$502.20

PELLETS CALC SULF 20C CSP2006S

Facility

$3,348.00

Hospital Charge Code	270628180
Hospital Revenue Code	272
Min. Negotiated Rate	$435.24
Max. Negotiated Rate	$1,674.00
Rate for Payer: Aetna Commercial	$1,004.40
Rate for Payer: Aetna Medicare Advantage	$1,004.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$853.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$853.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$853.74
Rate for Payer: Cigna Commercial	$1,674.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.24
Rate for Payer: Oxford Commercial	$1,674.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.20
Rate for Payer: UnitedHealthcare Commercial	$1,674.00

PELVIC

Facility

$6,700.00

Service Code	HCPCS 76856
Hospital Charge Code	94061179
Hospital Revenue Code	402
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PELVIC

Facility

$6,700.00

Service Code	HCPCS 76856
Hospital Charge Code	94061179
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC

Facility

$73,647.06

Service Code	MSDRG 734
Min. Negotiated Rate	$23,243.80
Max. Negotiated Rate	$73,647.06
Rate for Payer: Aetna Commercial	$71,823.34
Rate for Payer: Aetna Medicare Advantage	$23,243.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59,820.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59,820.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,549.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59,820.39
Rate for Payer: Cigna Commercial	$45,839.73
Rate for Payer: Cigna Medicare Advantage	$24,549.02
Rate for Payer: Clover Medicare Advantage	$23,321.57
Rate for Payer: EmblemHealth Commercial	$73,647.06
Rate for Payer: Humana Medicare Advantage	$25,285.49
Rate for Payer: Oxford Commercial	$28,648.50
Rate for Payer: UnitedHealthcare Commercial	$32,518.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,549.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26,021.96
Rate for Payer: Wellcare Medicare Advantage	$24,549.02

PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC

Facility

$50,876.34

Service Code	MSDRG 735
Min. Negotiated Rate	$14,682.88
Max. Negotiated Rate	$50,876.34
Rate for Payer: Aetna Commercial	$45,370.10
Rate for Payer: Aetna Medicare Advantage	$14,682.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,734.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,734.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,958.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,734.42
Rate for Payer: Cigna Commercial	$28,956.51
Rate for Payer: Cigna Medicare Advantage	$16,958.78
Rate for Payer: Clover Medicare Advantage	$16,110.84
Rate for Payer: EmblemHealth Commercial	$50,876.34
Rate for Payer: Humana Medicare Advantage	$17,467.54
Rate for Payer: Oxford Commercial	$18,096.97
Rate for Payer: UnitedHealthcare Commercial	$20,541.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,958.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17,976.31
Rate for Payer: Wellcare Medicare Advantage	$16,958.78

PELVIC EXAM,UNDER ANESTHESIA

Facility

$16,333.80

Service Code	HCPCS 57410
Hospital Charge Code	160000183
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$4,900.14
Rate for Payer: Aetna Medicare Advantage	$4,900.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,165.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,165.12
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	$4,165.12
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,123.39
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

PELVIC EXAM,UNDER ANESTHESIA

Facility

$16,333.80

Service Code	HCPCS 57410
Hospital Charge Code	160000183
Hospital Revenue Code	360
Min. Negotiated Rate	$2,450.07
Max. Negotiated Rate	$2,450.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07

PELVIC LONG STERILE SCREW

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	270681643
Hospital Revenue Code	278
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$75.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

PELVIC LONG STERILE SCREW

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	270681643
Hospital Revenue Code	278
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$93.00
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

PELVIS 1-2 VIEW

Facility

$5,100.00

Service Code	HCPCS 72170
Hospital Charge Code	94061089
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PELVIS 1-2 VIEW

Facility

$5,100.00

Service Code	HCPCS 72170
Hospital Charge Code	94061089
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

PELVIS COMPLETE

Facility

$5,100.00

Service Code	HCPCS 72190
Hospital Charge Code	94061091
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PELVIS COMPLETE

Facility

$5,100.00

Service Code	HCPCS 72190
Hospital Charge Code	94061091
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

PELVIS W/PO CONTRAST ONLY

Facility

$9,500.00

Service Code	HCPCS 72192
Hospital Charge Code	2200152
Hospital Revenue Code	352
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Better Health Medicaid	$300.88
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$306.90

Know your out-of-pocket cost for care.

All Charges