Heights University Hospital

All Charges

Charge

Type

Setting

Price

TUBE GASTROSTMY FLEX 24F 54738

Facility

$105.00

Hospital Charge Code	270302335
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

TUBE GASTROSTMY FLEX 24F 54738

Facility

$105.00

Hospital Charge Code	270302335
Hospital Revenue Code	272
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$52.50

TUBE GASTROSTO FLEXIFLO 20FR

Facility

$380.00

Hospital Charge Code	270601250
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$190.00

TUBE GASTROSTO FLEXIFLO 20FR

Facility

$380.00

Hospital Charge Code	270601250
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

TUBE GASTROSTO FLEXIFLO 22FR

Facility

$380.00

Hospital Charge Code	270600961
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$190.00

TUBE GASTROSTO FLEXIFLO 22FR

Facility

$380.00

Hospital Charge Code	270600961
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

TUBE GASTROSTO FLEXIFLO 24FR

Facility

$380.00

Hospital Charge Code	270601249
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$190.00

TUBE GASTROSTO FLEXIFLO 24FR

Facility

$380.00

Hospital Charge Code	270601249
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

TUBE GASTROSTO FLEXIFLO REPLCM

Facility

$380.00

Hospital Charge Code	270600962
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

TUBE GASTROSTO FLEXIFLO REPLCM

Facility

$380.00

Hospital Charge Code	270600962
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$190.00

TUBE GASTROSTOMY 14FR 5cc

Facility

$79.93

Hospital Charge Code	270647456
Hospital Revenue Code	271
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$39.97
Rate for Payer: Aetna Commercial	$23.98
Rate for Payer: Aetna Medicare Advantage	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.38
Rate for Payer: Cigna Commercial	$39.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.39
Rate for Payer: Oxford Commercial	$39.97
Rate for Payer: Qualcare PPO/HMO/WC	$11.99
Rate for Payer: UnitedHealthcare Commercial	$39.97

TUBE GASTROSTOMY 14FR 5cc

Facility

$79.93

Hospital Charge Code	270647456
Hospital Revenue Code	271
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$11.99
Rate for Payer: Qualcare PPO/HMO/WC	$11.99

TUBE GASTROSTOMY 22FR 6222

Facility

$136.50

Hospital Charge Code	270624936
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$68.25
Rate for Payer: Aetna Commercial	$40.95
Rate for Payer: Aetna Medicare Advantage	$40.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.81
Rate for Payer: Cigna Commercial	$68.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.75
Rate for Payer: Oxford Commercial	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.48
Rate for Payer: UnitedHealthcare Commercial	$68.25

TUBE GASTROSTOMY 22FR 6222

Facility

$136.50

Hospital Charge Code	270624936
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$20.48
Rate for Payer: Qualcare PPO/HMO/WC	$20.48

TUBE GASTROSTOMY 24FR

Facility

$380.40

Hospital Charge Code	270650026
Hospital Revenue Code	270
Min. Negotiated Rate	$49.45
Max. Negotiated Rate	$190.20
Rate for Payer: Aetna Commercial	$114.12
Rate for Payer: Aetna Medicare Advantage	$114.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.00
Rate for Payer: Cigna Commercial	$190.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.45
Rate for Payer: Oxford Commercial	$190.20
Rate for Payer: Qualcare PPO/HMO/WC	$57.06
Rate for Payer: UnitedHealthcare Commercial	$190.20

TUBE GASTROSTOMY 24FR

Facility

$380.40

Hospital Charge Code	270650026
Hospital Revenue Code	270
Min. Negotiated Rate	$57.06
Max. Negotiated Rate	$57.06
Rate for Payer: Qualcare PPO/HMO/WC	$57.06

TUBE GASTROSTOMY 24FR RL54738

Facility

$21.50

Hospital Charge Code	270650438
Hospital Revenue Code	272
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$10.75
Rate for Payer: Aetna Commercial	$6.45
Rate for Payer: Aetna Medicare Advantage	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.48
Rate for Payer: Cigna Commercial	$10.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.23
Rate for Payer: UnitedHealthcare Commercial	$10.75

TUBE GASTROSTOMY 24FR RL54738

Facility

$21.50

Hospital Charge Code	270650438
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.23

TUBE GASTROSTOMY MIC 16FR

Facility

$220.30

Hospital Charge Code	270672029
Hospital Revenue Code	272
Min. Negotiated Rate	$33.05
Max. Negotiated Rate	$33.05
Rate for Payer: Qualcare PPO/HMO/WC	$33.05

TUBE GASTROSTOMY MIC 16FR

Facility

$220.30

Hospital Charge Code	270672029N
Hospital Revenue Code	272
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$110.15
Rate for Payer: Aetna Commercial	$66.09
Rate for Payer: Aetna Medicare Advantage	$66.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.18
Rate for Payer: Cigna Commercial	$110.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.64
Rate for Payer: Oxford Commercial	$110.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.05
Rate for Payer: UnitedHealthcare Commercial	$110.15

TUBE GASTROSTOMY MIC 16FR

Facility

$220.30

Hospital Charge Code	270672029
Hospital Revenue Code	272
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$110.15
Rate for Payer: Aetna Commercial	$66.09
Rate for Payer: Aetna Medicare Advantage	$66.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.18
Rate for Payer: Cigna Commercial	$110.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.64
Rate for Payer: Oxford Commercial	$110.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.05
Rate for Payer: UnitedHealthcare Commercial	$110.15

TUBE GASTROSTOMY MIC 16FR

Facility

$220.30

Hospital Charge Code	270672029N
Hospital Revenue Code	272
Min. Negotiated Rate	$33.05
Max. Negotiated Rate	$33.05
Rate for Payer: Qualcare PPO/HMO/WC	$33.05

TUBE GASTROSTOMY MIC 18FR

Facility

$152.45

Hospital Charge Code	270661988N
Hospital Revenue Code	272
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$76.22
Rate for Payer: Aetna Commercial	$45.73
Rate for Payer: Aetna Medicare Advantage	$45.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.87
Rate for Payer: Cigna Commercial	$76.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.82
Rate for Payer: Oxford Commercial	$76.22
Rate for Payer: Qualcare PPO/HMO/WC	$22.87
Rate for Payer: UnitedHealthcare Commercial	$76.22

TUBE GASTROSTOMY MIC 18FR

Facility

$152.45

Hospital Charge Code	270661988N
Hospital Revenue Code	272
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$22.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.87

TUBE GASTROSTOMY MIC 18FR

Facility

$220.30

Hospital Charge Code	270669889S
Hospital Revenue Code	272
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$110.15
Rate for Payer: Aetna Commercial	$66.09
Rate for Payer: Aetna Medicare Advantage	$66.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.18
Rate for Payer: Cigna Commercial	$110.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.64
Rate for Payer: Oxford Commercial	$110.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.05
Rate for Payer: UnitedHealthcare Commercial	$110.15

Know your out-of-pocket cost for care.

All Charges