Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERI STENT PLACE-ADD

Facility

$24,869.00

Hospital Charge Code	7411135
Hospital Revenue Code	361
Min. Negotiated Rate	$3,730.35
Max. Negotiated Rate	$3,730.35
Rate for Payer: Qualcare PPO/HMO/WC	$3,730.35

PERI STENT PLACE-ADD

Facility

$24,869.00

Hospital Charge Code	7411135
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$12,434.50
Rate for Payer: Aetna Commercial	$7,460.70
Rate for Payer: Aetna Medicare Advantage	$7,460.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,341.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,341.60
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	$6,341.60
Rate for Payer: Cigna Commercial	$12,434.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,232.97
Rate for Payer: Qualcare PPO/HMO/WC	$3,730.35

PERI STENT PLACE-INITIAL

Facility

$53,150.12

Hospital Charge Code	7411133
Hospital Revenue Code	361
Min. Negotiated Rate	$7,972.52
Max. Negotiated Rate	$7,972.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,972.52

PERI STENT PLACE-INITIAL

Facility

$53,150.12

Hospital Charge Code	7411133
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$26,575.06
Rate for Payer: Aetna Commercial	$15,945.04
Rate for Payer: Aetna Medicare Advantage	$15,945.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,553.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,553.28
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	$13,553.28
Rate for Payer: Cigna Commercial	$26,575.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,909.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,972.52

PERI-STRIP

Facility

$330.00

Hospital Charge Code	270335371
Hospital Revenue Code	278
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.86
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

PERI-STRIP

Facility

$330.00

Hospital Charge Code	270335371
Hospital Revenue Code	278
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$79.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.86
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

PERI-STRIP 45MM

Facility

$1,071.00

Hospital Charge Code	270672596
Hospital Revenue Code	272
Min. Negotiated Rate	$139.23
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$321.30
Rate for Payer: Aetna Medicare Advantage	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.11
Rate for Payer: Cigna Commercial	$535.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.23
Rate for Payer: Oxford Commercial	$535.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.65
Rate for Payer: UnitedHealthcare Commercial	$535.50

PERI-STRIP 45MM

Facility

$1,071.00

Hospital Charge Code	270672596
Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$160.65

PERI-STRIP 60MM

Facility

$1,071.00

Hospital Charge Code	270672597
Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$160.65

PERI-STRIP 60MM

Facility

$1,071.00

Hospital Charge Code	270672597
Hospital Revenue Code	272
Min. Negotiated Rate	$139.23
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$321.30
Rate for Payer: Aetna Medicare Advantage	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.11
Rate for Payer: Cigna Commercial	$535.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.23
Rate for Payer: Oxford Commercial	$535.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.65
Rate for Payer: UnitedHealthcare Commercial	$535.50

PERI-STRP DRY STAP PSD4506-U-V

Facility

$979.13

Service Code	HCPCS C1762
Hospital Charge Code	270660315
Hospital Revenue Code	278
Min. Negotiated Rate	$146.87
Max. Negotiated Rate	$236.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.87

PERI-STRP DRY STAP PSD4506-U-V

Facility

$979.13

Service Code	HCPCS C1762
Hospital Charge Code	270660315
Hospital Revenue Code	278
Min. Negotiated Rate	$146.87
Max. Negotiated Rate	$489.56
Rate for Payer: Aetna Commercial	$293.74
Rate for Payer: Aetna Medicare Advantage	$293.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.68
Rate for Payer: Cigna Commercial	$489.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.87

PERI THREE D ENHANCEMENT

Facility

$276.00

Service Code	HCPCS 76376
Hospital Charge Code	74308085
Hospital Revenue Code	333
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

PERI THREE D ENHANCEMENT

Facility

$276.00

Service Code	HCPCS 76376
Hospital Charge Code	74308085
Hospital Revenue Code	333
Min. Negotiated Rate	$28.74
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$82.80
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$28.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

PERITONEAL ADHESIOLYSIS

Facility

$21,970.14

Service Code	APR-DRG 2242
Min. Negotiated Rate	$15,277.85
Max. Negotiated Rate	$21,970.14
Rate for Payer: Aetna Better Health Medicaid	$21,539.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,970.14
Rate for Payer: Wellpoint Medicaid Managed Care	$15,277.85

PERITONEAL ADHESIOLYSIS

Facility

$30,751.75

Service Code	APR-DRG 2243
Min. Negotiated Rate	$23,129.37
Max. Negotiated Rate	$30,751.75
Rate for Payer: Aetna Better Health Medicaid	$30,148.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,751.75
Rate for Payer: Wellpoint Medicaid Managed Care	$23,129.37

PERITONEAL ADHESIOLYSIS

Facility

$53,332.78

Service Code	APR-DRG 2244
Min. Negotiated Rate	$41,983.94
Max. Negotiated Rate	$53,332.78
Rate for Payer: Aetna Better Health Medicaid	$52,287.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$53,332.78
Rate for Payer: Wellpoint Medicaid Managed Care	$41,983.94

PERITONEAL ADHESIOLYSIS

Facility

$18,707.78

Service Code	APR-DRG 2241
Min. Negotiated Rate	$11,667.50
Max. Negotiated Rate	$18,707.78
Rate for Payer: Aetna Better Health Medicaid	$18,340.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,707.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11,667.50

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$73,028.79

Service Code	MSDRG 336
Min. Negotiated Rate	$23,011.36
Max. Negotiated Rate	$73,028.79
Rate for Payer: Oxford Commercial	$28,362.01
Rate for Payer: Aetna Commercial	$71,105.10
Rate for Payer: Aetna Medicare Advantage	$23,011.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,342.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,166.37
Rate for Payer: Cigna Commercial	$45,381.33
Rate for Payer: Cigna Medicare Advantage	$24,342.93
Rate for Payer: Clover Medicare Advantage	$23,125.78
Rate for Payer: EmblemHealth Commercial	$73,028.79
Rate for Payer: Humana Medicare Advantage	$25,073.22
Rate for Payer: UnitedHealthcare Commercial	$32,193.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,342.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25,803.51
Rate for Payer: Wellcare Medicare Advantage	$24,342.93

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$120,410.32

Service Code	MSDRG 335
Min. Negotiated Rate	$36,565.58
Max. Negotiated Rate	$120,410.32
Rate for Payer: Aetna Commercial	$120,410.32
Rate for Payer: Aetna Medicare Advantage	$38,967.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98,689.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98,689.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,490.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98,689.86
Rate for Payer: Cigna Commercial	$76,849.34
Rate for Payer: Cigna Medicare Advantage	$38,490.08
Rate for Payer: Clover Medicare Advantage	$36,565.58
Rate for Payer: EmblemHealth Commercial	$115,470.24
Rate for Payer: Humana Medicare Advantage	$39,644.78
Rate for Payer: Oxford Commercial	$48,028.61
Rate for Payer: UnitedHealthcare Commercial	$54,516.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,490.08
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$40,799.48
Rate for Payer: Wellcare Medicare Advantage	$38,490.08

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$56,376.72

Service Code	MSDRG 337
Min. Negotiated Rate	$16,750.81
Max. Negotiated Rate	$56,376.72
Rate for Payer: Aetna Commercial	$51,760.00
Rate for Payer: Aetna Medicare Advantage	$16,750.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,350.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,350.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,792.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,350.50
Rate for Payer: Cigna Commercial	$33,034.74
Rate for Payer: Cigna Medicare Advantage	$18,792.24
Rate for Payer: Clover Medicare Advantage	$17,852.63
Rate for Payer: EmblemHealth Commercial	$56,376.72
Rate for Payer: Humana Medicare Advantage	$19,356.01
Rate for Payer: Oxford Commercial	$20,645.75
Rate for Payer: UnitedHealthcare Commercial	$23,434.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,792.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19,919.77
Rate for Payer: Wellcare Medicare Advantage	$18,792.24

PERITONEAL LAVAGE W/IMG

Facility

$2,289.68

Service Code	HCPCS 49084
Hospital Charge Code	5780235
Hospital Revenue Code	450
Min. Negotiated Rate	$297.66
Max. Negotiated Rate	$2,159.89
Rate for Payer: Aetna Commercial	$686.90
Rate for Payer: Aetna Medicare Advantage	$686.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$583.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$583.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$583.87
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.66
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

PERITONEAL LAVAGE W/IMG

Facility

$2,289.68

Service Code	HCPCS 49084
Hospital Charge Code	5780235
Hospital Revenue Code	450
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

PERITONEAL WASHINGS

Facility

$264.85

Service Code	HCPCS 88104
Hospital Charge Code	3005348
Hospital Revenue Code	311
Min. Negotiated Rate	$34.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$79.45
Rate for Payer: Aetna Medicare Advantage	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.54
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$47.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.73
Rate for Payer: UnitedHealthcare Commercial	$114.00

PERITONEAL WASHINGS

Facility

$264.85

Service Code	HCPCS 88104
Hospital Charge Code	3005348
Hospital Revenue Code	311
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$39.73
Rate for Payer: Qualcare PPO/HMO/WC	$39.73

Know your out-of-pocket cost for care.

All Charges