Heights University Hospital

All Charges

Charge

Type

Setting

Price

TUBE TYMPANOST GROMMET BL 1.14

Facility

$70.83

Service Code	HCPCS A4649
Hospital Charge Code	270699382
Hospital Revenue Code	272
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$10.62
Rate for Payer: Qualcare PPO/HMO/WC	$10.62

TUBE TYMPANOST GROMMET BL 1.14

Facility

$70.83

Service Code	HCPCS A4649
Hospital Charge Code	270699382
Hospital Revenue Code	272
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$21.25
Rate for Payer: Aetna Medicare Advantage	$21.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.06
Rate for Payer: Cigna Commercial	$35.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.21
Rate for Payer: Oxford Commercial	$35.41
Rate for Payer: Qualcare PPO/HMO/WC	$10.62
Rate for Payer: UnitedHealthcare Commercial	$35.41

TUBE UNIVENT 7.0 ID CUFD H0056

Facility

$768.85

Hospital Charge Code	270633251
Hospital Revenue Code	272
Min. Negotiated Rate	$115.33
Max. Negotiated Rate	$115.33
Rate for Payer: Qualcare PPO/HMO/WC	$115.33

TUBE UNIVENT 7.0 ID CUFD H0056

Facility

$768.85

Hospital Charge Code	270633251
Hospital Revenue Code	272
Min. Negotiated Rate	$99.95
Max. Negotiated Rate	$384.43
Rate for Payer: Aetna Commercial	$230.66
Rate for Payer: Aetna Medicare Advantage	$230.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.06
Rate for Payer: Cigna Commercial	$384.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.95
Rate for Payer: Oxford Commercial	$384.43
Rate for Payer: Qualcare PPO/HMO/WC	$115.33
Rate for Payer: UnitedHealthcare Commercial	$384.43

TUBE UNIVENT 8.0 ID CUFD H0054

Facility

$768.85

Hospital Charge Code	270633250
Hospital Revenue Code	272
Min. Negotiated Rate	$115.33
Max. Negotiated Rate	$115.33
Rate for Payer: Qualcare PPO/HMO/WC	$115.33

TUBE UNIVENT 8.0 ID CUFD H0054

Facility

$768.85

Hospital Charge Code	270633250
Hospital Revenue Code	272
Min. Negotiated Rate	$99.95
Max. Negotiated Rate	$384.43
Rate for Payer: Aetna Commercial	$230.66
Rate for Payer: Aetna Medicare Advantage	$230.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.06
Rate for Payer: Cigna Commercial	$384.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.95
Rate for Payer: Oxford Commercial	$384.43
Rate for Payer: Qualcare PPO/HMO/WC	$115.33
Rate for Payer: UnitedHealthcare Commercial	$384.43

TUBE UNIVERSAL FEEDING ADAPT**

Facility

$22.00

Hospital Charge Code	2300713
Hospital Revenue Code	279
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

TUBE UNIVERSAL FEEDING ADAPT**

Facility

$22.00

Hospital Charge Code	2300713
Hospital Revenue Code	279
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$11.00

TUBE VENT FLURO PLASTIC R TYPE

Facility

$2,160.00

Hospital Charge Code	270655888
Hospital Revenue Code	272
Min. Negotiated Rate	$324.00
Max. Negotiated Rate	$324.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.00

TUBE VENT FLURO PLASTIC R TYPE

Facility

$2,160.00

Hospital Charge Code	270655888
Hospital Revenue Code	272
Min. Negotiated Rate	$280.80
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna Commercial	$648.00
Rate for Payer: Aetna Medicare Advantage	$648.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$550.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$550.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$550.80
Rate for Payer: Cigna Commercial	$1,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.80
Rate for Payer: Oxford Commercial	$1,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.00
Rate for Payer: UnitedHealthcare Commercial	$1,080.00

TUBE VENT SHPHRD GROMM MYRING

Facility

$53.79

Hospital Charge Code	270601241
Hospital Revenue Code	272
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.89
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.89

TUBE VENT SHPHRD GROMM MYRING

Facility

$53.79

Hospital Charge Code	270601241
Hospital Revenue Code	272
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

TUBE VINYL CONNECTING 40CM LNG

Facility

$63.75

Hospital Charge Code	270656104
Hospital Revenue Code	272
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$9.56
Rate for Payer: Qualcare PPO/HMO/WC	$9.56

TUBE VINYL CONNECTING 40CM LNG

Facility

$63.75

Hospital Charge Code	270656104
Hospital Revenue Code	272
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$31.88
Rate for Payer: Aetna Commercial	$19.12
Rate for Payer: Aetna Medicare Advantage	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.26
Rate for Payer: Cigna Commercial	$31.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.29
Rate for Payer: Oxford Commercial	$31.88
Rate for Payer: Qualcare PPO/HMO/WC	$9.56
Rate for Payer: UnitedHealthcare Commercial	$31.88

TUBE ViSiGi 3D FOR BYPASS 32FR

Facility

$848.00

Hospital Charge Code	270692086
Hospital Revenue Code	272
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

TUBE ViSiGi 3D FOR BYPASS 32FR

Facility

$848.00

Hospital Charge Code	270692086
Hospital Revenue Code	272
Min. Negotiated Rate	$110.24
Max. Negotiated Rate	$424.00
Rate for Payer: Aetna Commercial	$254.40
Rate for Payer: Aetna Medicare Advantage	$254.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.24
Rate for Payer: Cigna Commercial	$424.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.24
Rate for Payer: Oxford Commercial	$424.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.20
Rate for Payer: UnitedHealthcare Commercial	$424.00

TUBE ViSiGi 3D FOR BYPASS 36FR

Facility

$848.00

Hospital Charge Code	270692087
Hospital Revenue Code	272
Min. Negotiated Rate	$110.24
Max. Negotiated Rate	$424.00
Rate for Payer: Aetna Commercial	$254.40
Rate for Payer: Aetna Medicare Advantage	$254.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.24
Rate for Payer: Cigna Commercial	$424.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.24
Rate for Payer: Oxford Commercial	$424.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.20
Rate for Payer: UnitedHealthcare Commercial	$424.00

TUBE ViSiGi 3D FOR BYPASS 36FR

Facility

$848.00

Hospital Charge Code	270692087
Hospital Revenue Code	272
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

TUBE ViSiGi 3D FOR BYPASS 40FR

Facility

$848.00

Hospital Charge Code	270692088
Hospital Revenue Code	272
Min. Negotiated Rate	$110.24
Max. Negotiated Rate	$424.00
Rate for Payer: Aetna Commercial	$254.40
Rate for Payer: Aetna Medicare Advantage	$254.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.24
Rate for Payer: Cigna Commercial	$424.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.24
Rate for Payer: Oxford Commercial	$424.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.20
Rate for Payer: UnitedHealthcare Commercial	$424.00

TUBE ViSiGi 3D FOR BYPASS 40FR

Facility

$848.00

Hospital Charge Code	270692088
Hospital Revenue Code	272
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

TUBE VISIGI W/BULB 32FR

Facility

$848.00

Hospital Charge Code	270692043
Hospital Revenue Code	272
Min. Negotiated Rate	$110.24
Max. Negotiated Rate	$424.00
Rate for Payer: Aetna Commercial	$254.40
Rate for Payer: Aetna Medicare Advantage	$254.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.24
Rate for Payer: Cigna Commercial	$424.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.24
Rate for Payer: Oxford Commercial	$424.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.20
Rate for Payer: UnitedHealthcare Commercial	$424.00

TUBE VISIGI W/BULB 32FR

Facility

$848.00

Hospital Charge Code	270692043
Hospital Revenue Code	272
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

TUBE VISIGI W/BULB 36FR

Facility

$848.00

Hospital Charge Code	270692044
Hospital Revenue Code	272
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

TUBE VISIGI W/BULB 36FR

Facility

$848.00

Hospital Charge Code	270692044
Hospital Revenue Code	272
Min. Negotiated Rate	$110.24
Max. Negotiated Rate	$424.00
Rate for Payer: Aetna Commercial	$254.40
Rate for Payer: Aetna Medicare Advantage	$254.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.24
Rate for Payer: Cigna Commercial	$424.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.24
Rate for Payer: Oxford Commercial	$424.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.20
Rate for Payer: UnitedHealthcare Commercial	$424.00

TUBE VISIGI W/BULB 40FR

Facility

$848.00

Hospital Charge Code	270692045
Hospital Revenue Code	272
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

Know your out-of-pocket cost for care.

All Charges