Heights University Hospital

All Charges

Charge

Type

Setting

Price

PICC LINE 4FR SINGLE LUMEN IR

Facility

$760.50

Hospital Charge Code	270CH0061
Hospital Revenue Code	272
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

PICC LINE 4FR SINGLE LUMEN IR

Facility

$760.50

Hospital Charge Code	270CH0061
Hospital Revenue Code	272
Min. Negotiated Rate	$98.86
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$228.15
Rate for Payer: Aetna Medicare Advantage	$228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.93
Rate for Payer: Cigna Commercial	$380.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.86
Rate for Payer: Oxford Commercial	$380.25
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$380.25

PICC LINE 6FR LUMEN/70CM WIRE

Facility

$1,305.00

Hospital Charge Code	2709007031
Hospital Revenue Code	272
Min. Negotiated Rate	$169.65
Max. Negotiated Rate	$652.50
Rate for Payer: Aetna Commercial	$391.50
Rate for Payer: Aetna Medicare Advantage	$391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.77
Rate for Payer: Cigna Commercial	$652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.65
Rate for Payer: Oxford Commercial	$652.50
Rate for Payer: Qualcare PPO/HMO/WC	$195.75
Rate for Payer: UnitedHealthcare Commercial	$652.50

PICC LINE 6FR LUMEN/70CM WIRE

Facility

$1,305.00

Hospital Charge Code	2709007031
Hospital Revenue Code	272
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$195.75
Rate for Payer: Qualcare PPO/HMO/WC	$195.75

PICC LINE 6FR SINGLE LUMEN IR

Facility

$1,305.00

Hospital Charge Code	270CH0062
Hospital Revenue Code	272
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$195.75
Rate for Payer: Qualcare PPO/HMO/WC	$195.75

PICC LINE 6FR SINGLE LUMEN IR

Facility

$1,305.00

Hospital Charge Code	270CH0062
Hospital Revenue Code	272
Min. Negotiated Rate	$169.65
Max. Negotiated Rate	$652.50
Rate for Payer: Aetna Commercial	$391.50
Rate for Payer: Aetna Medicare Advantage	$391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.77
Rate for Payer: Cigna Commercial	$652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.65
Rate for Payer: Oxford Commercial	$652.50
Rate for Payer: Qualcare PPO/HMO/WC	$195.75
Rate for Payer: UnitedHealthcare Commercial	$652.50

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83090001
Hospital Revenue Code	361
Min. Negotiated Rate	$604.37
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,394.70
Rate for Payer: Aetna Medicare Advantage	$1,394.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.49
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	$1,185.49
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.37
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83092010
Hospital Revenue Code	361
Min. Negotiated Rate	$604.37
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,394.70
Rate for Payer: Aetna Medicare Advantage	$1,394.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.49
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	$1,185.49
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.37
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83090001
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83092010
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE INSERTION <5 YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83080010
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE INSERTION <5 YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83080010
Hospital Revenue Code	361
Min. Negotiated Rate	$604.37
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,394.70
Rate for Payer: Aetna Medicare Advantage	$1,394.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.49
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	$1,185.49
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.37
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

PICC LINE VAX DUAL LUM 5 45413

Facility

$510.00

Hospital Charge Code	270624317V
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

PICC LINE VAX DUAL LUM 5 45413

Facility

$510.00

Hospital Charge Code	270624317V
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

PICC LINE VAX DUAL LUM 5 45413

Facility

$455.75

Hospital Charge Code	270624317
Hospital Revenue Code	278
Min. Negotiated Rate	$68.36
Max. Negotiated Rate	$227.88
Rate for Payer: Aetna Commercial	$136.72
Rate for Payer: Aetna Medicare Advantage	$136.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.22
Rate for Payer: Cigna Commercial	$227.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.29
Rate for Payer: Qualcare PPO/HMO/WC	$68.36

PICC LINE VAX DUAL LUM 5 45413

Facility

$455.75

Hospital Charge Code	270624317
Hospital Revenue Code	278
Min. Negotiated Rate	$68.36
Max. Negotiated Rate	$110.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.29
Rate for Payer: Qualcare PPO/HMO/WC	$68.36

PICC PERPHRLLY INS CNTRL CAT**

Facility

$163.00

Hospital Charge Code	8003543
Hospital Revenue Code	272
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PICC PERPHRLLY INS CNTRL CAT**

Facility

$163.00

Hospital Charge Code	8003543
Hospital Revenue Code	272
Min. Negotiated Rate	$21.19
Max. Negotiated Rate	$81.50
Rate for Payer: Aetna Commercial	$48.90
Rate for Payer: Aetna Medicare Advantage	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.56
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.19
Rate for Payer: Oxford Commercial	$81.50
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$81.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	270664037
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	73662010
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	270664037
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	73662010
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 5FR

Facility

$608.50

Hospital Charge Code	270669641
Hospital Revenue Code	278
Min. Negotiated Rate	$91.28
Max. Negotiated Rate	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: Qualcare PPO/HMO/WC	$91.28

PICC SINGLE LUMEN 5FR

Facility

$608.50

Hospital Charge Code	270669641
Hospital Revenue Code	278
Min. Negotiated Rate	$91.28
Max. Negotiated Rate	$304.25
Rate for Payer: Aetna Commercial	$182.55
Rate for Payer: Aetna Medicare Advantage	$182.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.17
Rate for Payer: Cigna Commercial	$304.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: Qualcare PPO/HMO/WC	$91.28

PICC TOTAL REPLACEMENT

Facility

$4,221.55

Service Code	HCPCS 36584
Hospital Charge Code	73662005
Hospital Revenue Code	361
Min. Negotiated Rate	$548.80
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,266.46
Rate for Payer: Aetna Medicare Advantage	$1,266.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.50
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	$1,076.50
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.80
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.23
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

Know your out-of-pocket cost for care.

All Charges