Heights University Hospital

All Charges

Charge

Type

Setting

Price

TAP BLOCK

Facility

$2,196.25

Service Code	HCPCS 64486
Hospital Charge Code	1650116A
Hospital Revenue Code	361
Min. Negotiated Rate	$329.44
Max. Negotiated Rate	$329.44
Rate for Payer: Qualcare PPO/HMO/WC	$329.44

TAP BLOCK BI INJECTION

Facility

$1,147.71

Service Code	HCPCS 64488
Hospital Charge Code	16000333
Hospital Revenue Code	360
Min. Negotiated Rate	$172.16
Max. Negotiated Rate	$172.16
Rate for Payer: Qualcare PPO/HMO/WC	$172.16

TAP BLOCK BI INJECTION

Facility

$1,147.71

Service Code	HCPCS 64488
Hospital Charge Code	16000333
Hospital Revenue Code	360
Min. Negotiated Rate	$61.06
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$344.31
Rate for Payer: Aetna Medicare Advantage	$344.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.67
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	$292.67
Rate for Payer: Cigna Commercial	$61.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.16
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TAP BLOCK BILATERAL

Facility

$2,296.25

Service Code	HCPCS 64488
Hospital Charge Code	1650119
Hospital Revenue Code	361
Min. Negotiated Rate	$344.44
Max. Negotiated Rate	$344.44
Rate for Payer: Qualcare PPO/HMO/WC	$344.44

TAP BLOCK BILATERAL

Facility

$2,296.25

Service Code	HCPCS 64488
Hospital Charge Code	1650119
Hospital Revenue Code	361
Min. Negotiated Rate	$61.06
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$688.88
Rate for Payer: Aetna Medicare Advantage	$688.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.54
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	$585.54
Rate for Payer: Cigna Commercial	$61.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.51
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.44
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TAP BLOCK BY INFUSION

Facility

$6,663.00

Service Code	HCPCS 64489
Hospital Charge Code	1600000859
Hospital Revenue Code	360
Min. Negotiated Rate	$76.14
Max. Negotiated Rate	$1,998.90
Rate for Payer: Aetna Commercial	$1,998.90
Rate for Payer: Aetna Medicare Advantage	$1,998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.07
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	$1,699.07
Rate for Payer: Cigna Commercial	$76.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.19
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.45
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TAP BLOCK BY INFUSION

Facility

$6,663.00

Service Code	HCPCS 64489
Hospital Charge Code	1600000859
Hospital Revenue Code	360
Min. Negotiated Rate	$999.45
Max. Negotiated Rate	$999.45
Rate for Payer: Qualcare PPO/HMO/WC	$999.45

TAP BLOCK UNILATERAL

Facility

$2,296.25

Service Code	HCPCS 64486
Hospital Charge Code	1650118
Hospital Revenue Code	361
Min. Negotiated Rate	$52.11
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$688.88
Rate for Payer: Aetna Medicare Advantage	$688.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.54
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	$585.54
Rate for Payer: Cigna Commercial	$52.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.51
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.44
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TAP BLOCK UNILATERAL

Facility

$2,296.25

Service Code	HCPCS 64486
Hospital Charge Code	1650118
Hospital Revenue Code	361
Min. Negotiated Rate	$344.44
Max. Negotiated Rate	$344.44
Rate for Payer: Qualcare PPO/HMO/WC	$344.44

TAP BLOCK UNIL BY INJ

Facility

$1,147.71

Service Code	HCPCS 64486
Hospital Charge Code	16000461
Hospital Revenue Code	360
Min. Negotiated Rate	$172.16
Max. Negotiated Rate	$172.16
Rate for Payer: Qualcare PPO/HMO/WC	$172.16

TAP BLOCK UNIL BY INJ

Facility

$1,147.71

Service Code	HCPCS 64486
Hospital Charge Code	16000461
Hospital Revenue Code	360
Min. Negotiated Rate	$52.11
Max. Negotiated Rate	$1,864.00
Rate for Payer: Cigna Commercial	$52.11
Rate for Payer: Aetna Commercial	$344.31
Rate for Payer: Aetna Medicare Advantage	$344.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.67
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	$292.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.16
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TAP BX 2.7MM BT2703

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	270620188
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

TAP BX 2.7MM BT2703

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	270620188
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

TAP CANCELLOUS 4mm 2346-036

Facility

$152.00

Hospital Charge Code	270610291
Hospital Revenue Code	278
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

TAP CANCELLOUS 4mm 2346-036

Facility

$152.00

Hospital Charge Code	270610291
Hospital Revenue Code	278
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

TAP CANN CREO MIS 6.5MM

Facility

$2,055.00

Hospital Charge Code	270698075
Hospital Revenue Code	272
Min. Negotiated Rate	$267.15
Max. Negotiated Rate	$1,027.50
Rate for Payer: Aetna Commercial	$616.50
Rate for Payer: Aetna Medicare Advantage	$616.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$524.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$524.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$524.02
Rate for Payer: Cigna Commercial	$1,027.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.15
Rate for Payer: Oxford Commercial	$1,027.50
Rate for Payer: Qualcare PPO/HMO/WC	$308.25
Rate for Payer: UnitedHealthcare Commercial	$1,027.50

TAP CANN CREO MIS 6.5MM

Facility

$2,055.00

Hospital Charge Code	270698075
Hospital Revenue Code	272
Min. Negotiated Rate	$308.25
Max. Negotiated Rate	$308.25
Rate for Payer: Qualcare PPO/HMO/WC	$308.25

TAP CANNULATED 4.5MM

Facility

$875.00

Hospital Charge Code	270673452
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

TAP CANNULATED 4.5MM

Facility

$875.00

Hospital Charge Code	270673452
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.75
Rate for Payer: Oxford Commercial	$437.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$437.50

TAPE ADHESIVE 1

Facility

$7.25

Hospital Charge Code	270350130
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

TAPE ADHESIVE 1

Facility

$7.25

Hospital Charge Code	270350130
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

TAPE ADHESIVE 3

Facility

$11.25

Hospital Charge Code	270350140
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

TAPE ADHESIVE 3

Facility

$11.25

Hospital Charge Code	270350140
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

TAPE AUTOCLAVE BULK 3/4

Facility

$135.07

Hospital Charge Code	270656255
Hospital Revenue Code	271
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

TAPE AUTOCLAVE BULK 3/4

Facility

$135.07

Hospital Charge Code	270656255
Hospital Revenue Code	271
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$40.52
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.56
Rate for Payer: Oxford Commercial	$67.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$67.53

Know your out-of-pocket cost for care.

All Charges