Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLIADIN AB (IGG,A)I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

GLIADIN AB (IGG,A)I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

GLIADIN AB (IGG,A)II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

GLIADIN AB (IGG,A)II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

GLIADIN DEAMIDATED AB,IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900332
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GLIADIN DEAMIDATED AB,IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900332
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

GLIDE ADVANTAGE .014

Facility

$1,568.00

Hospital Charge Code	270684951N
Hospital Revenue Code	272
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Qualcare PPO/HMO/WC	$235.20

GLIDE ADVANTAGE .014

Facility

$1,568.00

Hospital Charge Code	270684951N
Hospital Revenue Code	272
Min. Negotiated Rate	$203.84
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$470.40
Rate for Payer: Aetna Medicare Advantage	$470.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.84
Rate for Payer: Cigna Commercial	$784.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.84
Rate for Payer: Oxford Commercial	$784.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.20
Rate for Payer: UnitedHealthcare Commercial	$784.00

GLIDECATH 4FR - 100 CM SIM 2

Facility

$357.50

Hospital Charge Code	270CH0087
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 100 CM SIM 2

Facility

$357.50

Hospital Charge Code	270CH0087
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR-100 CM SIM 2

Facility

$357.50

Hospital Charge Code	2709004138
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR-100 CM SIM 2

Facility

$357.50

Hospital Charge Code	2709004138
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 100 CM STRAIGH

Facility

$357.50

Hospital Charge Code	270658287
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 100 CM STRAIGH

Facility

$357.50

Hospital Charge Code	270658287
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR - 65 CM C1

Facility

$357.50

Hospital Charge Code	270CH0099
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR - 65 CM C1

Facility

$357.50

Hospital Charge Code	270CH0099
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR-65CM C1

Facility

$357.50

Hospital Charge Code	2709004216
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR-65CM C1

Facility

$357.50

Hospital Charge Code	2709004216
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 65CM STRAIGHT

Facility

$357.50

Service Code	HCPCS C1887
Hospital Charge Code	270645472
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$86.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.52
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 65CM STRAIGHT

Facility

$357.50

Service Code	HCPCS C1887
Hospital Charge Code	270645472
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.52
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR-65CM STRAIGHT

Facility

$357.50

Hospital Charge Code	2709004130
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR-65CM STRAIGHT

Facility

$357.50

Hospital Charge Code	2709004130
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - C2 65 CM

Facility

$357.50

Hospital Charge Code	270CH0085
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

GLIDECATH 4FR - C2 65 CM

Facility

$357.50

Hospital Charge Code	270CH0085
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR -C2 65 CM

Facility

$357.50

Hospital Charge Code	2709003411
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

Know your out-of-pocket cost for care.

All Charges