Heights University Hospital

All Charges

Charge

Type

Setting

Price

REPLACE G/C TUBE PERC

Facility

$270.35

Service Code	HCPCS 49450
Hospital Charge Code	5792271
Hospital Revenue Code	450
Min. Negotiated Rate	$40.55
Max. Negotiated Rate	$40.55
Rate for Payer: Qualcare PPO/HMO/WC	$40.55

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	411043762
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	404643762
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	321043762
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	323043762
Hospital Revenue Code	450
Min. Negotiated Rate	$151.58
Max. Negotiated Rate	$594.98
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	366843762
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	404643762
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	411043762
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	321043762
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	323043762
Hospital Revenue Code	450
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	366843762
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	321043763
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	404643763
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	404643763
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	411043763
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	323043763
Hospital Revenue Code	450
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	366843763
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	323043763
Hospital Revenue Code	450
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$594.98
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	366843763
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	411043763
Hospital Revenue Code	361
Min. Negotiated Rate	$176.38
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$407.03
Rate for Payer: Aetna Medicare Advantage	$407.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.98
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	$345.98
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE G TUBE W REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43763
Hospital Charge Code	321043763
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

REPLACE PICC CATH

Facility

$3,931.88

Service Code	HCPCS 36584
Hospital Charge Code	16000737
Hospital Revenue Code	360
Min. Negotiated Rate	$589.78
Max. Negotiated Rate	$589.78
Rate for Payer: Qualcare PPO/HMO/WC	$589.78

REPLACE PICC CATH

Facility

$3,931.88

Service Code	HCPCS 36584
Hospital Charge Code	16000737
Hospital Revenue Code	360
Min. Negotiated Rate	$511.14
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,179.56
Rate for Payer: Aetna Medicare Advantage	$1,179.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,002.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,002.63
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	$1,002.63
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.14
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$589.78
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

REP LACERAT 2.5 CM/<; FLR-MOUT

Facility

$511.12

Service Code	HCPCS 41250
Hospital Charge Code	16000960
Hospital Revenue Code	360
Min. Negotiated Rate	$76.67
Max. Negotiated Rate	$76.67
Rate for Payer: Qualcare PPO/HMO/WC	$76.67

REP LACERAT 2.5 CM/<; FLR-MOUT

Facility

$511.12

Service Code	HCPCS 41250
Hospital Charge Code	16000960
Hospital Revenue Code	360
Min. Negotiated Rate	$66.45
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$153.34
Rate for Payer: Aetna Medicare Advantage	$153.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.34
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	$130.34
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.45
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.67
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges