Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH MT GLIDE 5 100 32-139

Facility

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270623514S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

CATH MT GLIDE 5 100 32-139

Facility

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270623514O
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

CATH MT GLIDE 5 100 32-139

Facility

$71.50

Service Code	HCPCS C1887
Hospital Charge Code	270623514N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$35.75
Rate for Payer: Aetna Commercial	$21.45
Rate for Payer: Aetna Medicare Advantage	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.23
Rate for Payer: Cigna Commercial	$35.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

CATH MT GLIDE 5 100 32-139

Facility

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270623514S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$75.97
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

CATH MT GLIDE 5 100 32-139

Facility

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270623514O
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$75.97
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

CATH MT GLIDE 5 100 32-139

Facility

$253.25

Service Code	HCPCS C1887
Hospital Charge Code	270623514
Hospital Revenue Code	278
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$61.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99

CATH MT NEPHROSTOMY 10F 27-180

Facility

$435.25

Hospital Charge Code	270623766V
Hospital Revenue Code	278
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$217.62
Rate for Payer: Aetna Commercial	$130.57
Rate for Payer: Aetna Medicare Advantage	$130.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.99
Rate for Payer: Cigna Commercial	$217.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.33
Rate for Payer: Qualcare PPO/HMO/WC	$65.29

CATH MT NEPHROSTOMY 10F 27-180

Facility

$435.25

Hospital Charge Code	270623766V
Hospital Revenue Code	278
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$105.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.33
Rate for Payer: Qualcare PPO/HMO/WC	$65.29

CATH MT NEPHROSTOMY 12F 27-181

Facility

$435.25

Hospital Charge Code	270623971V
Hospital Revenue Code	278
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$105.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.33
Rate for Payer: Qualcare PPO/HMO/WC	$65.29

CATH MT NEPHROSTOMY 12F 27-181

Facility

$435.25

Hospital Charge Code	270623971V
Hospital Revenue Code	278
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$217.62
Rate for Payer: Aetna Commercial	$130.57
Rate for Payer: Aetna Medicare Advantage	$130.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.99
Rate for Payer: Cigna Commercial	$217.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.33
Rate for Payer: Qualcare PPO/HMO/WC	$65.29

CATH MT SYNERGY 10M 4C 19 481

Facility

$1,344.00

Hospital Charge Code	270625145
Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$403.20
Rate for Payer: Aetna Medicare Advantage	$403.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.72
Rate for Payer: Cigna Commercial	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: Qualcare PPO/HMO/WC	$201.60

CATH MT SYNERGY 10M 4C 19 481

Facility

$1,344.00

Hospital Charge Code	270625145
Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: Qualcare PPO/HMO/WC	$201.60

CATH MT SYNERGY 5X4 19-328

Facility

$1,418.45

Hospital Charge Code	270625134
Hospital Revenue Code	278
Min. Negotiated Rate	$212.77
Max. Negotiated Rate	$709.23
Rate for Payer: Aetna Commercial	$425.54
Rate for Payer: Aetna Medicare Advantage	$425.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.70
Rate for Payer: Cigna Commercial	$709.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.26
Rate for Payer: Qualcare PPO/HMO/WC	$212.77

CATH MT SYNERGY 5X4 19-328

Facility

$1,418.45

Hospital Charge Code	270625134
Hospital Revenue Code	278
Min. Negotiated Rate	$212.77
Max. Negotiated Rate	$343.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.26
Rate for Payer: Qualcare PPO/HMO/WC	$212.77

CATH MT UDT/10-4/5/75 16-525

Facility

$1,224.85

Hospital Charge Code	270623525
Hospital Revenue Code	272
Min. Negotiated Rate	$159.23
Max. Negotiated Rate	$612.42
Rate for Payer: Aetna Commercial	$367.45
Rate for Payer: Aetna Medicare Advantage	$367.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.34
Rate for Payer: Cigna Commercial	$612.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.23
Rate for Payer: Oxford Commercial	$612.42
Rate for Payer: Qualcare PPO/HMO/WC	$183.73
Rate for Payer: UnitedHealthcare Commercial	$612.42

CATH MT UDT/10-4/5/75 16-525

Facility

$1,224.85

Hospital Charge Code	270623525V
Hospital Revenue Code	278
Min. Negotiated Rate	$183.73
Max. Negotiated Rate	$296.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.41
Rate for Payer: Qualcare PPO/HMO/WC	$183.73

CATH MT UDT/10-4/5/75 16-525

Facility

$1,224.85

Hospital Charge Code	270623525
Hospital Revenue Code	272
Min. Negotiated Rate	$183.73
Max. Negotiated Rate	$183.73
Rate for Payer: Qualcare PPO/HMO/WC	$183.73

CATH MT UDT/10-4/5/75 16-525

Facility

$1,224.85

Hospital Charge Code	270623525V
Hospital Revenue Code	278
Min. Negotiated Rate	$183.73
Max. Negotiated Rate	$612.42
Rate for Payer: Aetna Commercial	$367.45
Rate for Payer: Aetna Medicare Advantage	$367.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.34
Rate for Payer: Cigna Commercial	$612.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.41
Rate for Payer: Qualcare PPO/HMO/WC	$183.73

CATH MT UDT/5-4/5/75 16-443

Facility

$1,895.25

Hospital Charge Code	270618562V
Hospital Revenue Code	272
Min. Negotiated Rate	$246.38
Max. Negotiated Rate	$947.62
Rate for Payer: Aetna Commercial	$568.58
Rate for Payer: Aetna Medicare Advantage	$568.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.29
Rate for Payer: Cigna Commercial	$947.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.38
Rate for Payer: Oxford Commercial	$947.62
Rate for Payer: Qualcare PPO/HMO/WC	$284.29
Rate for Payer: UnitedHealthcare Commercial	$947.62

CATH MT UDT/5-4/5/75 16-443

Facility

$1,895.25

Hospital Charge Code	270618562V
Hospital Revenue Code	272
Min. Negotiated Rate	$284.29
Max. Negotiated Rate	$284.29
Rate for Payer: Qualcare PPO/HMO/WC	$284.29

CATH MT UDT/8-4/5.8T/75 16-505

Facility

$1,954.45

Hospital Charge Code	270616370V
Hospital Revenue Code	278
Min. Negotiated Rate	$293.17
Max. Negotiated Rate	$977.23
Rate for Payer: Aetna Commercial	$586.34
Rate for Payer: Aetna Medicare Advantage	$586.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$498.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$498.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$390.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$498.38
Rate for Payer: Cigna Commercial	$977.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.98
Rate for Payer: Qualcare PPO/HMO/WC	$293.17

CATH MT UDT/8-4/5.8T/75 16-505

Facility

$1,954.45

Hospital Charge Code	270616370V
Hospital Revenue Code	278
Min. Negotiated Rate	$293.17
Max. Negotiated Rate	$472.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$390.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.98
Rate for Payer: Qualcare PPO/HMO/WC	$293.17

CATH MT URET UT/4 4/5/75 14309

Facility

$1,821.65

Hospital Charge Code	270601085
Hospital Revenue Code	272
Min. Negotiated Rate	$273.25
Max. Negotiated Rate	$273.25
Rate for Payer: Qualcare PPO/HMO/WC	$273.25

CATH MT URET UT/4 4/5/75 14309

Facility

$1,821.65

Hospital Charge Code	270601085
Hospital Revenue Code	272
Min. Negotiated Rate	$236.81
Max. Negotiated Rate	$910.83
Rate for Payer: Aetna Commercial	$546.50
Rate for Payer: Aetna Medicare Advantage	$546.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$464.52
Rate for Payer: Cigna Commercial	$910.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.81
Rate for Payer: Oxford Commercial	$910.83
Rate for Payer: Qualcare PPO/HMO/WC	$273.25
Rate for Payer: UnitedHealthcare Commercial	$910.83

CATH MT URET UT/5-4/5/75 14318

Facility

$2,301.65

Hospital Charge Code	270601086
Hospital Revenue Code	272
Min. Negotiated Rate	$345.25
Max. Negotiated Rate	$345.25
Rate for Payer: Qualcare PPO/HMO/WC	$345.25

Know your out-of-pocket cost for care.

All Charges