Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERCLOSE PROSTYLE 12773-03

Facility

$1,200.00

Service Code	HCPCS C1760
Hospital Charge Code	270694951S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

PERCLOSE PROSTYLE 12773-03

Facility

$1,200.00

Service Code	HCPCS C1760
Hospital Charge Code	270694951S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
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) NJ Health	$240.00
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	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

PERC N BX ABD /RETROPERITNL M

Facility

$8,404.60

Service Code	HCPCS 49180
Hospital Charge Code	160000198
Hospital Revenue Code	360
Min. Negotiated Rate	$1,092.60
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,521.38
Rate for Payer: Aetna Medicare Advantage	$2,521.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,143.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,143.17
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	$2,143.17
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,092.60
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.69
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

PERC N BX ABD /RETROPERITNL M

Facility

$8,404.60

Service Code	HCPCS 49180
Hospital Charge Code	160000198
Hospital Revenue Code	360
Min. Negotiated Rate	$1,260.69
Max. Negotiated Rate	$1,260.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.69

PERC NDL CORE BRST BX WO GUID

Facility

$4,884.50

Service Code	HCPCS 19100
Hospital Charge Code	16000788
Hospital Revenue Code	360
Min. Negotiated Rate	$634.99
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,465.35
Rate for Payer: Aetna Medicare Advantage	$1,465.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,245.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,245.55
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	$1,245.55
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.99
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.67
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

PERC NDL CORE BRST BX WO GUID

Facility

$4,884.50

Service Code	HCPCS 19100
Hospital Charge Code	16000788
Hospital Revenue Code	360
Min. Negotiated Rate	$732.67
Max. Negotiated Rate	$732.67
Rate for Payer: Qualcare PPO/HMO/WC	$732.67

PERC NEPHROSTOLITHOTOMY,TO 2CM

Facility

$39,246.40

Service Code	HCPCS 50080
Hospital Charge Code	1600000679
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$22,543.37
Rate for Payer: Aetna Commercial	$11,773.92
Rate for Payer: Aetna Medicare Advantage	$11,773.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,007.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,007.83
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	$10,007.83
Rate for Payer: Cigna Commercial	$22,543.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,102.03
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,886.96
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

PERC NEPHROSTOLITHOTOMY,TO 2CM

Facility

$39,246.40

Service Code	HCPCS 50080
Hospital Charge Code	1600000679
Hospital Revenue Code	360
Min. Negotiated Rate	$5,886.96
Max. Negotiated Rate	$5,886.96
Rate for Payer: Qualcare PPO/HMO/WC	$5,886.96

PERCOCET/TAB

Facility

$4.00

Hospital Charge Code	60633627
Hospital Revenue Code	250
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

PERCOCET/TAB

Facility

$4.00

Hospital Charge Code	60633627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PERCOCET/TAB

Facility

$3.00

Hospital Charge Code	60633628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERCOCET/TAB

Facility

$3.00

Hospital Charge Code	60633628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERCODAN/TAB

Facility

$3.00

Hospital Charge Code	60633629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERCODAN/TAB

Facility

$3.00

Hospital Charge Code	60633629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERC PLACE IVC FILTER

Facility

$8,658.00

Hospital Charge Code	2009015
Hospital Revenue Code	320
Min. Negotiated Rate	$1,298.70
Max. Negotiated Rate	$1,298.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,298.70

PERC PLACE IVC FILTER

Facility

$8,658.00

Hospital Charge Code	2009015
Hospital Revenue Code	320
Min. Negotiated Rate	$1,125.54
Max. Negotiated Rate	$4,329.00
Rate for Payer: Aetna Commercial	$2,597.40
Rate for Payer: Aetna Medicare Advantage	$2,597.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,207.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,207.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,207.79
Rate for Payer: Cigna Commercial	$4,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.54
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,298.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERC PLACMNT OF ENTEROCLYSIS T

Facility

$766.60

Service Code	HCPCS 44015
Hospital Charge Code	1600000345
Hospital Revenue Code	360
Min. Negotiated Rate	$99.66
Max. Negotiated Rate	$6,873.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.99
Rate for Payer: Aetna Commercial	$229.98
Rate for Payer: Aetna Medicare Advantage	$229.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.48
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	$195.48
Rate for Payer: Cigna Commercial	$136.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.66
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PERC PLACMNT OF ENTEROCLYSIS T

Facility

$766.60

Service Code	HCPCS 44015
Hospital Charge Code	1600000345
Hospital Revenue Code	360
Min. Negotiated Rate	$114.99
Max. Negotiated Rate	$114.99
Rate for Payer: Qualcare PPO/HMO/WC	$114.99

PERC PORTAL VEIN CATHETEZATION

Facility

$3,987.20

Service Code	HCPCS 36481
Hospital Charge Code	16000734
Hospital Revenue Code	360
Min. Negotiated Rate	$302.67
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,196.16
Rate for Payer: Aetna Medicare Advantage	$1,196.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,016.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,016.74
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	$1,016.74
Rate for Payer: Cigna Commercial	$302.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$518.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$598.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

PERC PORTAL VEIN CATHETEZATION

Facility

$3,987.20

Service Code	HCPCS 36481
Hospital Charge Code	16000734
Hospital Revenue Code	360
Min. Negotiated Rate	$598.08
Max. Negotiated Rate	$598.08
Rate for Payer: Qualcare PPO/HMO/WC	$598.08

PERC PRE-BENT ROD 70MM

Facility

$1,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270703858
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

PERC PRE-BENT ROD 70MM

Facility

$1,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270703858
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

PERC PRE-BENT ROD 70MM

Facility

$1,325.00

Service Code	HCPCS C1889
Hospital Charge Code	2707038583
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

PERC PRE-BENT ROD 70MM

Facility

$1,325.00

Service Code	HCPCS C1889
Hospital Charge Code	2707038583
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

PERC ROD 150MM

Facility

$1,541.05

Hospital Charge Code	270703338
Hospital Revenue Code	279
Min. Negotiated Rate	$231.16
Max. Negotiated Rate	$231.16
Rate for Payer: Qualcare PPO/HMO/WC	$231.16

Know your out-of-pocket cost for care.

All Charges