Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH URETERAL 5FR 70cm OPENEND

Facility

$80.56

Hospital Charge Code	270679486
Hospital Revenue Code	272
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$12.08
Rate for Payer: Qualcare PPO/HMO/WC	$12.08

CATH URETERAL 5FR 70cm OPENEND

Facility

$80.56

Hospital Charge Code	270679486
Hospital Revenue Code	272
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$40.28
Rate for Payer: Aetna Commercial	$24.17
Rate for Payer: Aetna Medicare Advantage	$24.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.54
Rate for Payer: Cigna Commercial	$40.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.47
Rate for Payer: Oxford Commercial	$40.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.08
Rate for Payer: UnitedHealthcare Commercial	$40.28

CATH URETERAL CONE TIP

Facility

$1,611.15

Hospital Charge Code	270658676
Hospital Revenue Code	272
Min. Negotiated Rate	$209.45
Max. Negotiated Rate	$805.58
Rate for Payer: Aetna Commercial	$483.35
Rate for Payer: Aetna Medicare Advantage	$483.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.84
Rate for Payer: Cigna Commercial	$805.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.45
Rate for Payer: Oxford Commercial	$805.58
Rate for Payer: Qualcare PPO/HMO/WC	$241.67
Rate for Payer: UnitedHealthcare Commercial	$805.58

CATH URETERAL CONE TIP

Facility

$1,611.15

Hospital Charge Code	270658676
Hospital Revenue Code	272
Min. Negotiated Rate	$241.67
Max. Negotiated Rate	$241.67
Rate for Payer: Qualcare PPO/HMO/WC	$241.67

CATH URETERAL CONE TIP 8FR

Facility

$34.40

Service Code	HCPCS C1758
Hospital Charge Code	270658365
Hospital Revenue Code	278
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$17.20
Rate for Payer: Aetna Commercial	$10.32
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.77
Rate for Payer: Cigna Commercial	$17.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.16

CATH URETERAL CONE TIP 8FR

Facility

$34.40

Service Code	HCPCS C1758
Hospital Charge Code	270658365
Hospital Revenue Code	278
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.16

CATH URETERAL CONE TIP 8FR

Facility

$231.00

Service Code	HCPCS C1758
Hospital Charge Code	270331131
Hospital Revenue Code	278
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$55.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.90
Rate for Payer: Qualcare PPO/HMO/WC	$34.65

CATH URETERAL CONE TIP 8FR

Facility

$231.00

Service Code	HCPCS C1758
Hospital Charge Code	270331131
Hospital Revenue Code	278
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$115.50
Rate for Payer: Aetna Commercial	$69.30
Rate for Payer: Aetna Medicare Advantage	$69.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.91
Rate for Payer: Cigna Commercial	$115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.90
Rate for Payer: Qualcare PPO/HMO/WC	$34.65

CATH URETERAL DUAL LUMAN

Facility

$167.40

Service Code	HCPCS C1758
Hospital Charge Code	270647884
Hospital Revenue Code	278
Min. Negotiated Rate	$25.11
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: Aetna Medicare Advantage	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.69
Rate for Payer: Cigna Commercial	$83.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.51
Rate for Payer: Qualcare PPO/HMO/WC	$25.11

CATH URETERAL DUAL LUMAN

Facility

$167.40

Service Code	HCPCS C1758
Hospital Charge Code	270647884
Hospital Revenue Code	278
Min. Negotiated Rate	$25.11
Max. Negotiated Rate	$40.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.51
Rate for Payer: Qualcare PPO/HMO/WC	$25.11

CATH URETERAL OLIVE TIP 3FR

Facility

$213.80

Service Code	HCPCS C1758
Hospital Charge Code	270650800
Hospital Revenue Code	278
Min. Negotiated Rate	$32.07
Max. Negotiated Rate	$51.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.74
Rate for Payer: Qualcare PPO/HMO/WC	$32.07

CATH URETERAL OLIVE TIP 3FR

Facility

$213.80

Service Code	HCPCS C1758
Hospital Charge Code	270650800
Hospital Revenue Code	278
Min. Negotiated Rate	$32.07
Max. Negotiated Rate	$106.90
Rate for Payer: Aetna Commercial	$64.14
Rate for Payer: Aetna Medicare Advantage	$64.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.52
Rate for Payer: Cigna Commercial	$106.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.74
Rate for Payer: Qualcare PPO/HMO/WC	$32.07

CATH URETERAL OLIVETIP 4FR

Facility

$190.55

Service Code	HCPCS C1758
Hospital Charge Code	270644065
Hospital Revenue Code	278
Min. Negotiated Rate	$28.58
Max. Negotiated Rate	$46.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.11
Rate for Payer: Qualcare PPO/HMO/WC	$28.58

CATH URETERAL OLIVETIP 4FR

Facility

$190.55

Service Code	HCPCS C1758
Hospital Charge Code	270644065
Hospital Revenue Code	278
Min. Negotiated Rate	$28.58
Max. Negotiated Rate	$95.28
Rate for Payer: Aetna Commercial	$57.16
Rate for Payer: Aetna Medicare Advantage	$57.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.59
Rate for Payer: Cigna Commercial	$95.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.11
Rate for Payer: Qualcare PPO/HMO/WC	$28.58

CATH URETERAL OLIVETIP 5FR

Facility

$244.50

Hospital Charge Code	270646262
Hospital Revenue Code	278
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$59.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.17
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

CATH URETERAL OLIVETIP 5FR

Facility

$244.50

Hospital Charge Code	270646262
Hospital Revenue Code	278
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$122.25
Rate for Payer: Aetna Commercial	$73.35
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.17
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

CATH URETERAL OLIVE TIP 6FR

Facility

$373.20

Service Code	HCPCS C1758
Hospital Charge Code	270646263
Hospital Revenue Code	278
Min. Negotiated Rate	$55.98
Max. Negotiated Rate	$90.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.31
Rate for Payer: Qualcare PPO/HMO/WC	$55.98

CATH URETERAL OLIVE TIP 6FR

Facility

$373.20

Service Code	HCPCS C1758
Hospital Charge Code	270646263
Hospital Revenue Code	278
Min. Negotiated Rate	$55.98
Max. Negotiated Rate	$186.60
Rate for Payer: Aetna Commercial	$111.96
Rate for Payer: Aetna Medicare Advantage	$111.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.17
Rate for Payer: Cigna Commercial	$186.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.31
Rate for Payer: Qualcare PPO/HMO/WC	$55.98

CATH URETERAL OP-END 5F 135005

Facility

$38.00

Hospital Charge Code	270618083
Hospital Revenue Code	272
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

CATH URETERAL OP-END 5F 135005

Facility

$38.00

Hospital Charge Code	270618083
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

CATH URETERAL POLY WHIS TIP

Facility

$32.65

Service Code	HCPCS C1729
Hospital Charge Code	270659735
Hospital Revenue Code	278
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna Commercial	$9.79
Rate for Payer: Aetna Medicare Advantage	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.33
Rate for Payer: Cigna Commercial	$16.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

CATH URETERAL POLY WHIS TIP

Facility

$32.65

Service Code	HCPCS C1729
Hospital Charge Code	270659735
Hospital Revenue Code	278
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

CATH URETERAL TIGERTAIL 5FR

Facility

$49.75

Service Code	HCPCS C1758
Hospital Charge Code	270660500
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$24.88
Rate for Payer: Aetna Commercial	$14.93
Rate for Payer: Aetna Medicare Advantage	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.69
Rate for Payer: Cigna Commercial	$24.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.04
Rate for Payer: Qualcare PPO/HMO/WC	$7.46

CATH URETERAL TIGERTAIL 5FR

Facility

$49.75

Service Code	HCPCS C1758
Hospital Charge Code	270660500
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$12.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.04
Rate for Payer: Qualcare PPO/HMO/WC	$7.46

CATH URETERAL TIP #5 WHISTLE

Facility

$214.95

Hospital Charge Code	270658470
Hospital Revenue Code	272
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$32.24
Rate for Payer: Qualcare PPO/HMO/WC	$32.24

Know your out-of-pocket cost for care.

All Charges