Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH HEMOD DURAFLOW 15.5F 28CM

Facility

$850.00

Service Code	HCPCS C1750
Hospital Charge Code	270698675
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH HEMOD DURAFLOW 15.5F 28CM

Facility

$850.00

Service Code	HCPCS C1750
Hospital Charge Code	270698675
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH HEMO DUALL LM W/CF #SL28

Facility

$688.00

Hospital Charge Code	270607038
Hospital Revenue Code	272
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$103.20
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

CATH HEMO DUALL LM W/CF #SL28

Facility

$688.00

Hospital Charge Code	270607038
Hospital Revenue Code	272
Min. Negotiated Rate	$89.44
Max. Negotiated Rate	$344.00
Rate for Payer: Aetna Commercial	$206.40
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.44
Rate for Payer: Oxford Commercial	$344.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Commercial	$344.00

CATH HEMOSPILT 42CM 5734423

Facility

$1,925.00

Hospital Charge Code	270641384
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$577.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH HEMOSPILT 42CM 5734423

Facility

$1,925.00

Hospital Charge Code	270641384
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH HEMOSPLIT 35CM 5733353

Facility

$1,925.00

Hospital Charge Code	270641383
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$577.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH HEMOSPLIT 35CM 5733353

Facility

$1,925.00

Hospital Charge Code	270641383
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH HEMOSPLIT STD 19CM

Facility

$1,488.00

Service Code	HCPCS C1750
Hospital Charge Code	270657877S
Hospital Revenue Code	278
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$744.00
Rate for Payer: Aetna Commercial	$446.40
Rate for Payer: Aetna Medicare Advantage	$446.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.44
Rate for Payer: Cigna Commercial	$744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.10
Rate for Payer: Qualcare PPO/HMO/WC	$223.20

CATH HEMOSPLIT STD 19CM

Facility

$1,488.00

Service Code	HCPCS C1750
Hospital Charge Code	270657877
Hospital Revenue Code	278
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$744.00
Rate for Payer: Aetna Commercial	$446.40
Rate for Payer: Aetna Medicare Advantage	$446.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.44
Rate for Payer: Cigna Commercial	$744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.10
Rate for Payer: Qualcare PPO/HMO/WC	$223.20

CATH HEMOSPLIT STD 19CM

Facility

$1,488.00

Service Code	HCPCS C1750
Hospital Charge Code	270657877S
Hospital Revenue Code	278
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$360.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.10
Rate for Payer: Qualcare PPO/HMO/WC	$223.20

CATH HEMOSPLIT STD 19CM

Facility

$1,488.00

Service Code	HCPCS C1750
Hospital Charge Code	270657877
Hospital Revenue Code	278
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$360.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.10
Rate for Payer: Qualcare PPO/HMO/WC	$223.20

CATH HEMOSPLIT STD 23CM

Facility

$1,775.00

Service Code	HCPCS C1750
Hospital Charge Code	270657882S
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$887.50
Rate for Payer: Aetna Commercial	$532.50
Rate for Payer: Aetna Medicare Advantage	$532.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.62
Rate for Payer: Cigna Commercial	$887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CATH HEMOSPLIT STD 23CM

Facility

$1,775.00

Service Code	HCPCS C1750
Hospital Charge Code	270657882
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$887.50
Rate for Payer: Aetna Commercial	$532.50
Rate for Payer: Aetna Medicare Advantage	$532.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.62
Rate for Payer: Cigna Commercial	$887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CATH HEMOSPLIT STD 23CM

Facility

$1,775.00

Service Code	HCPCS C1750
Hospital Charge Code	270657882S
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$429.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CATH HEMOSPLIT STD 23CM

Facility

$1,775.00

Service Code	HCPCS C1750
Hospital Charge Code	270657882
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$429.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CATH HEMOSPLIT STD KIT 19CM

Facility

$1,525.00

Service Code	HCPCS C1750
Hospital Charge Code	270642139
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

CATH HEMOSPLIT STD KIT 19CM

Facility

$1,525.00

Service Code	HCPCS C1750
Hospital Charge Code	270642139
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$457.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

CATH HICKM 45CM 13.5 60045-2

Facility

$2,119.25

Hospital Charge Code	270601092
Hospital Revenue Code	278
Min. Negotiated Rate	$317.89
Max. Negotiated Rate	$1,059.62
Rate for Payer: Aetna Commercial	$635.77
Rate for Payer: Aetna Medicare Advantage	$635.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.41
Rate for Payer: Cigna Commercial	$1,059.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.86
Rate for Payer: Qualcare PPO/HMO/WC	$317.89

CATH HICKM 45CM 13.5 60045-2

Facility

$2,119.25

Hospital Charge Code	270601092
Hospital Revenue Code	278
Min. Negotiated Rate	$317.89
Max. Negotiated Rate	$512.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.86
Rate for Payer: Qualcare PPO/HMO/WC	$317.89

CATH HICKMAN DUAL PED 28CM

Facility

$1,005.00

Hospital Charge Code	270655420
Hospital Revenue Code	278
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$243.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.21
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

CATH HICKMAN DUAL PED 28CM

Facility

$1,005.00

Hospital Charge Code	270655420
Hospital Revenue Code	278
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$502.50
Rate for Payer: Aetna Commercial	$301.50
Rate for Payer: Aetna Medicare Advantage	$301.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.27
Rate for Payer: Cigna Commercial	$502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.21
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

CATH HICKMAN DUAL W/VITA CUFF

Facility

$830.00

Service Code	HCPCS C1750
Hospital Charge Code	270655422
Hospital Revenue Code	278
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$249.00
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.86
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

CATH HICKMAN DUAL W/VITA CUFF

Facility

$830.00

Service Code	HCPCS C1750
Hospital Charge Code	270655422
Hospital Revenue Code	278
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$200.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.86
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

CATH HICKM DUAL 13.5 60069-2

Facility

$2,119.25

Hospital Charge Code	270602964
Hospital Revenue Code	272
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$1,059.62
Rate for Payer: Aetna Commercial	$635.77
Rate for Payer: Aetna Medicare Advantage	$635.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.41
Rate for Payer: Cigna Commercial	$1,059.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.50
Rate for Payer: Oxford Commercial	$1,059.62
Rate for Payer: Qualcare PPO/HMO/WC	$317.89
Rate for Payer: UnitedHealthcare Commercial	$1,059.62

Know your out-of-pocket cost for care.

All Charges