Heights University Hospital

All Charges

Charge

Type

Setting

Price

TPRLC 133 T1 PPS SO 20X160MM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 TYPE 1 PPS SO 17.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679848
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 TYPE 1 PPS SO 17.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679848
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR FP TYPE1 PPS 5X130MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR FP TYPE1 PPS 5X130MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR T1 PPS 10 X 140 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687014
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR T1 PPS 10 X 140 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687014
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPTLC 133 T1PPS SO 13X146MMTP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682727
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPTLC 133 T1PPS SO 13X146MMTP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682727
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TRACH 6.0 XLT PROXIMAL CUFFED

Facility

$317.75

Hospital Charge Code	270639966
Hospital Revenue Code	272
Min. Negotiated Rate	$47.66
Max. Negotiated Rate	$47.66
Rate for Payer: Qualcare PPO/HMO/WC	$47.66

TRACH 6.0 XLT PROXIMAL CUFFED

Facility

$317.75

Hospital Charge Code	270639966
Hospital Revenue Code	272
Min. Negotiated Rate	$41.31
Max. Negotiated Rate	$158.88
Rate for Payer: Aetna Commercial	$95.33
Rate for Payer: Aetna Medicare Advantage	$95.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.03
Rate for Payer: Cigna Commercial	$158.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.31
Rate for Payer: Oxford Commercial	$158.88
Rate for Payer: Qualcare PPO/HMO/WC	$47.66
Rate for Payer: UnitedHealthcare Commercial	$158.88

TRACH CARE

Facility

$88.00

Hospital Charge Code	8001729
Hospital Revenue Code	270
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$26.40
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$44.00

TRACH CARE

Facility

$88.00

Hospital Charge Code	8001729
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

TRACH CARE BALLARD 221

Facility

$30.83

Hospital Charge Code	270645434
Hospital Revenue Code	272
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$15.41
Rate for Payer: Aetna Commercial	$9.25
Rate for Payer: Aetna Medicare Advantage	$9.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.86
Rate for Payer: Cigna Commercial	$15.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.01
Rate for Payer: Oxford Commercial	$15.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.62
Rate for Payer: UnitedHealthcare Commercial	$15.41

TRACH CARE BALLARD 221

Facility

$30.83

Hospital Charge Code	270645434
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$4.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.62

TRACH CARE KIT 14FR. WITH

Facility

$120.00

Hospital Charge Code	270330844
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$60.00

TRACH CARE KIT 14FR. WITH

Facility

$120.00

Hospital Charge Code	270330844
Hospital Revenue Code	272
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

TRACH CARE KIT 16FR. WITH

Facility

$180.00

Hospital Charge Code	270330843
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$90.00

TRACH CARE KIT 16FR. WITH

Facility

$180.00

Hospital Charge Code	270330843
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

TRACH CARE T-P ENDO 0598000220

Facility

$33.50

Hospital Charge Code	270633414
Hospital Revenue Code	272
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$16.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$16.75

TRACH CARE T-P ENDO 0598000220

Facility

$33.50

Hospital Charge Code	270633414
Hospital Revenue Code	272
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

TRACH CARE TP TRACH 0598220135

Facility

$31.00

Hospital Charge Code	270633413
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$15.50

TRACH CARE TP TRACH 0598220135

Facility

$31.00

Hospital Charge Code	270633413
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

TRACH CLS SYS DIR TIP W/ CLR

Facility

$37.85

Hospital Charge Code	270659655
Hospital Revenue Code	272
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$5.68
Rate for Payer: Qualcare PPO/HMO/WC	$5.68

TRACH CLS SYS DIR TIP W/ CLR

Facility

$37.85

Hospital Charge Code	270659655
Hospital Revenue Code	272
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$18.93
Rate for Payer: Aetna Commercial	$11.36
Rate for Payer: Aetna Medicare Advantage	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.65
Rate for Payer: Cigna Commercial	$18.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.92
Rate for Payer: Oxford Commercial	$18.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.68
Rate for Payer: UnitedHealthcare Commercial	$18.93

Know your out-of-pocket cost for care.

All Charges