Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH URET POLLK 6F 70cm 021306

Facility

$92.45

Service Code	HCPCS C1758
Hospital Charge Code	270643425
Hospital Revenue Code	278
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$46.23
Rate for Payer: Aetna Commercial	$27.73
Rate for Payer: Aetna Medicare Advantage	$27.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$46.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.37
Rate for Payer: Qualcare PPO/HMO/WC	$13.87

CATH URET POLLK 6F 70cm 021306

Facility

$92.45

Service Code	HCPCS C1758
Hospital Charge Code	270643425
Hospital Revenue Code	278
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$22.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.37
Rate for Payer: Qualcare PPO/HMO/WC	$13.87

CATH URET RTNR 5/70CM****

Facility

$31.00

Hospital Charge Code	270605215
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$15.50

CATH URET RTNR 5/70CM****

Facility

$31.00

Hospital Charge Code	270605215
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

CATH URET SPRL TIP 4FR

Facility

$135.00

Hospital Charge Code	270331134
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

CATH URET SPRL TIP 4FR

Facility

$135.00

Hospital Charge Code	270331134
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

CATH URET STONE DU LUMN 405100

Facility

$297.65

Hospital Charge Code	270626129
Hospital Revenue Code	278
Min. Negotiated Rate	$44.65
Max. Negotiated Rate	$72.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.03
Rate for Payer: Qualcare PPO/HMO/WC	$44.65

CATH URET STONE DU LUMN 405100

Facility

$297.65

Hospital Charge Code	270626129
Hospital Revenue Code	278
Min. Negotiated Rate	$44.65
Max. Negotiated Rate	$148.82
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$89.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.90
Rate for Payer: Cigna Commercial	$148.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.03
Rate for Payer: Qualcare PPO/HMO/WC	$44.65

CATH UROMA KIT 6MM/18FR

Facility

$2,363.25

Hospital Charge Code	270601089
Hospital Revenue Code	272
Min. Negotiated Rate	$354.49
Max. Negotiated Rate	$354.49
Rate for Payer: Qualcare PPO/HMO/WC	$354.49

CATH UROMA KIT 6MM/18FR

Facility

$2,363.25

Hospital Charge Code	270601089
Hospital Revenue Code	272
Min. Negotiated Rate	$307.22
Max. Negotiated Rate	$1,181.62
Rate for Payer: Aetna Commercial	$708.98
Rate for Payer: Aetna Medicare Advantage	$708.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$602.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$602.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$602.63
Rate for Payer: Cigna Commercial	$1,181.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.22
Rate for Payer: Oxford Commercial	$1,181.62
Rate for Payer: Qualcare PPO/HMO/WC	$354.49
Rate for Payer: UnitedHealthcare Commercial	$1,181.62

CATH UTHIN DIAMD 12x4x75 16533

Facility

$1,716.90

Hospital Charge Code	270630327V
Hospital Revenue Code	278
Min. Negotiated Rate	$257.54
Max. Negotiated Rate	$858.45
Rate for Payer: Aetna Commercial	$515.07
Rate for Payer: Aetna Medicare Advantage	$515.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.81
Rate for Payer: Cigna Commercial	$858.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$415.49
Rate for Payer: Qualcare PPO/HMO/WC	$257.54

CATH UTHIN DIAMD 12x4x75 16533

Facility

$1,703.25

Hospital Charge Code	270630327
Hospital Revenue Code	278
Min. Negotiated Rate	$255.49
Max. Negotiated Rate	$851.62
Rate for Payer: Aetna Commercial	$510.98
Rate for Payer: Aetna Medicare Advantage	$510.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.33
Rate for Payer: Cigna Commercial	$851.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.19
Rate for Payer: Qualcare PPO/HMO/WC	$255.49

CATH UTHIN DIAMD 12x4x75 16533

Facility

$1,703.25

Hospital Charge Code	270630327
Hospital Revenue Code	278
Min. Negotiated Rate	$255.49
Max. Negotiated Rate	$412.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.19
Rate for Payer: Qualcare PPO/HMO/WC	$255.49

CATH UTHIN DIAMD 12x4x75 16533

Facility

$1,716.90

Hospital Charge Code	270630327V
Hospital Revenue Code	278
Min. Negotiated Rate	$257.54
Max. Negotiated Rate	$415.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$415.49
Rate for Payer: Qualcare PPO/HMO/WC	$257.54

CATH U/THIN DIAMD 6x2 5F 16457

Facility

$1,020.00

Hospital Charge Code	270629350V
Hospital Revenue Code	278
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.84
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATH U/THIN DIAMD 6x2 5F 16457

Facility

$1,020.00

Hospital Charge Code	270629350V
Hospital Revenue Code	278
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$246.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.84
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATH U/THIN DIAMOND 135c 17638

Facility

$1,080.00

Hospital Charge Code	270632829V
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$324.00
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.36
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

CATH U/THIN DIAMOND 135c 17638

Facility

$1,080.00

Hospital Charge Code	270632829V
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$261.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.36
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

CATH U/THIN DIAMOND 135c 17638

Facility

$1,071.45

Hospital Charge Code	270632829
Hospital Revenue Code	278
Min. Negotiated Rate	$160.72
Max. Negotiated Rate	$535.73
Rate for Payer: Aetna Commercial	$321.44
Rate for Payer: Aetna Medicare Advantage	$321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.22
Rate for Payer: Cigna Commercial	$535.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.29
Rate for Payer: Qualcare PPO/HMO/WC	$160.72

CATH U/THIN DIAMOND 135c 17638

Facility

$1,071.45

Hospital Charge Code	270632829
Hospital Revenue Code	278
Min. Negotiated Rate	$160.72
Max. Negotiated Rate	$259.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.29
Rate for Payer: Qualcare PPO/HMO/WC	$160.72

CATH U/THIN DIM 12x4x120 16534

Facility

$1,703.25

Hospital Charge Code	270627287
Hospital Revenue Code	278
Min. Negotiated Rate	$255.49
Max. Negotiated Rate	$412.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.19
Rate for Payer: Qualcare PPO/HMO/WC	$255.49

CATH U/THIN DIM 12x4x120 16534

Facility

$1,703.25

Hospital Charge Code	270627287V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.49
Max. Negotiated Rate	$851.62
Rate for Payer: Aetna Commercial	$510.98
Rate for Payer: Aetna Medicare Advantage	$510.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.33
Rate for Payer: Cigna Commercial	$851.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.19
Rate for Payer: Qualcare PPO/HMO/WC	$255.49

CATH U/THIN DIM 12x4x120 16534

Facility

$1,703.25

Hospital Charge Code	270627287V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.49
Max. Negotiated Rate	$412.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.19
Rate for Payer: Qualcare PPO/HMO/WC	$255.49

CATH U/THIN DIM 12x4x120 16534

Facility

$1,703.25

Hospital Charge Code	270627287
Hospital Revenue Code	278
Min. Negotiated Rate	$255.49
Max. Negotiated Rate	$851.62
Rate for Payer: Aetna Commercial	$510.98
Rate for Payer: Aetna Medicare Advantage	$510.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.33
Rate for Payer: Cigna Commercial	$851.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.19
Rate for Payer: Qualcare PPO/HMO/WC	$255.49

CATH U/THIN S 5F 4-8 135 17578

Facility

$1,071.45

Hospital Charge Code	270634116
Hospital Revenue Code	278
Min. Negotiated Rate	$160.72
Max. Negotiated Rate	$259.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.29
Rate for Payer: Qualcare PPO/HMO/WC	$160.72

Know your out-of-pocket cost for care.

All Charges