Heights University Hospital

All Charges

Charge

Type

Setting

Price

TUBE SALEM SUMP 18FR 48

Facility

$7.97

Service Code	HCPCS C1729
Hospital Charge Code	270650091
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$2.39
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$3.98

TUBE SALEM SUMP 18FR 48

Facility

$7.97

Service Code	HCPCS C1729
Hospital Charge Code	270650091
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

TUBE SALIVARY BYPASS SIZE #10

Facility

$875.00

Hospital Charge Code	270643555
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

TUBE SALIVARY BYPASS SIZE #10

Facility

$875.00

Hospital Charge Code	270643555
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

TUBES CHLORINE TEST 10ML

Facility

$10.55

Hospital Charge Code	270658821
Hospital Revenue Code	270
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$5.28
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna Medicare Advantage	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.69
Rate for Payer: Cigna Commercial	$5.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.37
Rate for Payer: Oxford Commercial	$5.28
Rate for Payer: Qualcare PPO/HMO/WC	$1.58
Rate for Payer: UnitedHealthcare Commercial	$5.28

TUBES CHLORINE TEST 10ML

Facility

$10.55

Hospital Charge Code	270658821
Hospital Revenue Code	270
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.58

TUBE SET CYSTOMETRY

Facility

$28.50

Hospital Charge Code	270658601
Hospital Revenue Code	270
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$8.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.27
Rate for Payer: Cigna Commercial	$14.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.71
Rate for Payer: Oxford Commercial	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$14.25

TUBE SET CYSTOMETRY

Facility

$28.50

Hospital Charge Code	270658601
Hospital Revenue Code	270
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.28

TUBE SET SMOKE PNEUMCLEAR

Facility

$165.22

Hospital Charge Code	270686704
Hospital Revenue Code	272
Min. Negotiated Rate	$24.78
Max. Negotiated Rate	$24.78
Rate for Payer: Qualcare PPO/HMO/WC	$24.78

TUBE SET SMOKE PNEUMCLEAR

Facility

$165.22

Hospital Charge Code	270686704
Hospital Revenue Code	272
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$82.61
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.13
Rate for Payer: Cigna Commercial	$82.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.48
Rate for Payer: Oxford Commercial	$82.61
Rate for Payer: Qualcare PPO/HMO/WC	$24.78
Rate for Payer: UnitedHealthcare Commercial	$82.61

TUBE SHEPHARD TEFLON ******

Facility

$28.00

Hospital Charge Code	1600667
Hospital Revenue Code	272
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

TUBE SHEPHARD TEFLON ******

Facility

$28.00

Hospital Charge Code	1600667
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

TUBE SILASTIC .03 X .065 10FT

Facility

$104.00

Hospital Charge Code	270332020
Hospital Revenue Code	272
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

TUBE SILASTIC .03 X .065 10FT

Facility

$104.00

Hospital Charge Code	270332020
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

TUBE SMN EXCH RUSL-TYLR 415113

Facility

$928.00

Hospital Charge Code	270621509
Hospital Revenue Code	270
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$464.00
Rate for Payer: Aetna Commercial	$278.40
Rate for Payer: Aetna Medicare Advantage	$278.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.64
Rate for Payer: Cigna Commercial	$464.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.64
Rate for Payer: Oxford Commercial	$464.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.20
Rate for Payer: UnitedHealthcare Commercial	$464.00

TUBE SMN EXCH RUSL-TYLR 415113

Facility

$928.00

Hospital Charge Code	270621509
Hospital Revenue Code	270
Min. Negotiated Rate	$139.20
Max. Negotiated Rate	$139.20
Rate for Payer: Qualcare PPO/HMO/WC	$139.20

TUBE SPLIT FEUERSTEIN VENT

Facility

$61.80

Hospital Charge Code	270649941
Hospital Revenue Code	272
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$9.27

TUBE SPLIT FEUERSTEIN VENT

Facility

$61.80

Hospital Charge Code	270649941
Hospital Revenue Code	272
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$30.90
Rate for Payer: Aetna Commercial	$18.54
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.76
Rate for Payer: Cigna Commercial	$30.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.03
Rate for Payer: Oxford Commercial	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.27
Rate for Payer: UnitedHealthcare Commercial	$30.90

TUBE SUCTION KAMVAC STD

Facility

$280.00

Hospital Charge Code	270676729
Hospital Revenue Code	272
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$84.00
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.40
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$140.00

TUBE SUCTION KAMVAC STD

Facility

$280.00

Hospital Charge Code	270676729
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

TUBE SUCTION MULTIHOLE

Facility

$240.00

Hospital Charge Code	270667406
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

TUBE SUCTION MULTIHOLE

Facility

$240.00

Hospital Charge Code	270667406
Hospital Revenue Code	272
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$120.00

TUBE SUCTION MULTIHOLE 5FR

Facility

$222.50

Hospital Charge Code	270667408
Hospital Revenue Code	272
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$33.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.38

TUBE SUCTION MULTIHOLE 5FR

Facility

$222.50

Hospital Charge Code	270667408
Hospital Revenue Code	272
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$111.25
Rate for Payer: Aetna Commercial	$66.75
Rate for Payer: Aetna Medicare Advantage	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.74
Rate for Payer: Cigna Commercial	$111.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.93
Rate for Payer: Oxford Commercial	$111.25
Rate for Payer: Qualcare PPO/HMO/WC	$33.38
Rate for Payer: UnitedHealthcare Commercial	$111.25

TUBE SUMP LONG WEIGHTED 16FR

Facility

$374.00

Hospital Charge Code	270645121
Hospital Revenue Code	271
Min. Negotiated Rate	$48.62
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna Medicare Advantage	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.37
Rate for Payer: Cigna Commercial	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.62
Rate for Payer: Oxford Commercial	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.10
Rate for Payer: UnitedHealthcare Commercial	$187.00

Know your out-of-pocket cost for care.

All Charges