Heights University Hospital

All Charges

Charge

Type

Setting

Price

FILTER RBC BLOOD BANK EZPF

Facility

$198.45

Hospital Charge Code	3100245
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$59.53
Rate for Payer: Aetna Medicare Advantage	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.60
Rate for Payer: Cigna Commercial	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.80
Rate for Payer: Oxford Commercial	$99.22
Rate for Payer: Qualcare PPO/HMO/WC	$29.77
Rate for Payer: UnitedHealthcare Commercial	$99.22

FILTER RBC BLOOD BANK EZPF

Facility

$198.45

Hospital Charge Code	3100245
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$29.77

FILTER RBC (PALL)

Facility

$113.65

Hospital Charge Code	3100237
Hospital Revenue Code	272
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$56.83
Rate for Payer: Aetna Commercial	$34.09
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.77
Rate for Payer: Oxford Commercial	$56.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$56.83

FILTER RBC (PALL)

Facility

$113.65

Hospital Charge Code	3100237
Hospital Revenue Code	272
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

FILTERS 20 X 25 X 2 PERFECT

Facility

$11.60

Hospital Charge Code	270658439
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.74

FILTERS 20 X 25 X 2 PERFECT

Facility

$11.60

Hospital Charge Code	270658439
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.80
Rate for Payer: Aetna Commercial	$3.48
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.96
Rate for Payer: Cigna Commercial	$5.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.74
Rate for Payer: UnitedHealthcare Commercial	$5.80

FILTER SET EXT 1.2 MICRON

Facility

$17.90

Hospital Charge Code	270649500
Hospital Revenue Code	272
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$5.37
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.95

FILTER SET EXT 1.2 MICRON

Facility

$17.90

Hospital Charge Code	270649500
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

FILTER SUBMIC 2 25 10FILTPK02

Facility

$24.00

Hospital Charge Code	270636450C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

FILTER SUBMIC 2 25 10FILTPK02

Facility

$24.00

Hospital Charge Code	270636450C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$12.00

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER SYSTEM ELITE VENA CAVA

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294N
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER SYSTEM ELITE VENA CAVA

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294N
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,342.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER TRI LUMEN TUBE CHARCOAL

Facility

$2,626.50

Hospital Charge Code	270686722
Hospital Revenue Code	272
Min. Negotiated Rate	$393.98
Max. Negotiated Rate	$393.98
Rate for Payer: Qualcare PPO/HMO/WC	$393.98

FILTER TRI LUMEN TUBE CHARCOAL

Facility

$2,626.50

Hospital Charge Code	270686722
Hospital Revenue Code	272
Min. Negotiated Rate	$341.44
Max. Negotiated Rate	$1,313.25
Rate for Payer: Aetna Commercial	$787.95
Rate for Payer: Aetna Medicare Advantage	$787.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.76
Rate for Payer: Cigna Commercial	$1,313.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.44
Rate for Payer: Oxford Commercial	$1,313.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.98
Rate for Payer: UnitedHealthcare Commercial	$1,313.25

FILTER TRIMED IV

Facility

$10.92

Hospital Charge Code	270041080
Hospital Revenue Code	272
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.46
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.46

FILTER TRIMED IV

Facility

$10.92

Hospital Charge Code	270041080
Hospital Revenue Code	272
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

FILTER TRT VENA CAVA 466P306A

Facility

$3,125.00

Service Code	HCPCS C1880
Hospital Charge Code	270627443
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

FILTER TRT VENA CAVA 466P306A

Facility

$3,125.00

Service Code	HCPCS C1880
Hospital Charge Code	270627443
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

FILTER VACUUM MIX FUME 5049-81

Facility

$215.25

Hospital Charge Code	270600226
Hospital Revenue Code	270
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Qualcare PPO/HMO/WC	$32.29

FILTER VACUUM MIX FUME 5049-81

Facility

$215.25

Hospital Charge Code	270600226
Hospital Revenue Code	270
Min. Negotiated Rate	$27.98
Max. Negotiated Rate	$107.62
Rate for Payer: Aetna Commercial	$64.58
Rate for Payer: Aetna Medicare Advantage	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.89
Rate for Payer: Cigna Commercial	$107.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.98
Rate for Payer: Oxford Commercial	$107.62
Rate for Payer: Qualcare PPO/HMO/WC	$32.29
Rate for Payer: UnitedHealthcare Commercial	$107.62

FILTER VACUUM MIXING FUME*****

Facility

$82.00

Hospital Charge Code	1606250
Hospital Revenue Code	279
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$41.00

Know your out-of-pocket cost for care.

All Charges