Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLIDECATH TORCON NB SIM1 5F 10

Facility

$74.30

Service Code	HCPCS C1887
Hospital Charge Code	270681566S
Hospital Revenue Code	278
Min. Negotiated Rate	$11.14
Max. Negotiated Rate	$37.15
Rate for Payer: Aetna Commercial	$22.29
Rate for Payer: Aetna Medicare Advantage	$22.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.95
Rate for Payer: Cigna Commercial	$37.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.14

GLIDE POWERGLIDE 10 CM

Facility

$570.00

Service Code	HCPCS C1887
Hospital Charge Code	270690135
Hospital Revenue Code	278
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$137.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.94
Rate for Payer: Qualcare PPO/HMO/WC	$85.50

GLIDE POWERGLIDE 10 CM

Facility

$570.00

Service Code	HCPCS C1887
Hospital Charge Code	270690135
Hospital Revenue Code	278
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$285.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.35
Rate for Payer: Cigna Commercial	$285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.94
Rate for Payer: Qualcare PPO/HMO/WC	$85.50

GLIDERITE STYLET LARGE

Facility

$50.00

Hospital Charge Code	270689167
Hospital Revenue Code	272
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$25.00

GLIDERITE STYLET LARGE

Facility

$50.00

Hospital Charge Code	270689167
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

GLIDERITE SU STYLET

Facility

$30.00

Hospital Charge Code	270689157
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

GLIDERITE SU STYLET

Facility

$30.00

Hospital Charge Code	270689157
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

GLIDESCOPE BFLEX 5.0

Facility

$1,475.00

Hospital Charge Code	270689145
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

GLIDESCOPE BFLEX 5.0

Facility

$1,475.00

Hospital Charge Code	270689145
Hospital Revenue Code	272
Min. Negotiated Rate	$191.75
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.75
Rate for Payer: Oxford Commercial	$737.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$737.50

GLIDESCOPE BFLEX 5.0 MM

Facility

$1,700.00

Hospital Charge Code	270690090
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$850.00

GLIDESCOPE BFLEX 5.0 MM

Facility

$1,700.00

Hospital Charge Code	270690090
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

GLIDESCOPE BFLEX 5.8

Facility

$1,700.00

Hospital Charge Code	270689144
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$850.00

GLIDESCOPE BFLEX 5.8

Facility

$1,700.00

Hospital Charge Code	270689144
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

GLIDESCOPE BFLEX 5.8 MM

Facility

$1,700.00

Hospital Charge Code	270690089
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

GLIDESCOPE BFLEX 5.8 MM

Facility

$1,700.00

Hospital Charge Code	270690089
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$850.00

GLIDESCOPE CORE ONE TOUCH

Facility

$72,765.00

Hospital Charge Code	270689146
Hospital Revenue Code	272
Min. Negotiated Rate	$10,914.75
Max. Negotiated Rate	$10,914.75
Rate for Payer: Qualcare PPO/HMO/WC	$10,914.75

GLIDESCOPE CORE ONE TOUCH

Facility

$72,765.00

Hospital Charge Code	270689146
Hospital Revenue Code	272
Min. Negotiated Rate	$9,459.45
Max. Negotiated Rate	$36,382.50
Rate for Payer: Aetna Commercial	$21,829.50
Rate for Payer: Aetna Medicare Advantage	$21,829.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,555.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,555.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,555.08
Rate for Payer: Cigna Commercial	$36,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,459.45
Rate for Payer: Oxford Commercial	$36,382.50
Rate for Payer: Qualcare PPO/HMO/WC	$10,914.75
Rate for Payer: UnitedHealthcare Commercial	$36,382.50

GLIDESCOPE LOPRO S1

Facility

$260.00

Hospital Charge Code	270683598
Hospital Revenue Code	272
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$130.00

GLIDESCOPE LOPRO S1

Facility

$260.00

Hospital Charge Code	270683598
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

GLIDESCOPE LPPRO 2.5 PEDS DISP

Facility

$114.50

Hospital Charge Code	270678444
Hospital Revenue Code	272
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$57.25
Rate for Payer: Aetna Commercial	$34.35
Rate for Payer: Aetna Medicare Advantage	$34.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.20
Rate for Payer: Cigna Commercial	$57.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.88
Rate for Payer: Oxford Commercial	$57.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.18
Rate for Payer: UnitedHealthcare Commercial	$57.25

GLIDESCOPE LPPRO 2.5 PEDS DISP

Facility

$114.50

Hospital Charge Code	270678444
Hospital Revenue Code	272
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$17.18
Rate for Payer: Qualcare PPO/HMO/WC	$17.18

GLIDESHEATH 6FR

Facility

$211.50

Service Code	HCPCS C1894
Hospital Charge Code	270686954N
Hospital Revenue Code	278
Min. Negotiated Rate	$31.73
Max. Negotiated Rate	$105.75
Rate for Payer: Aetna Commercial	$63.45
Rate for Payer: Aetna Medicare Advantage	$63.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.93
Rate for Payer: Cigna Commercial	$105.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.18
Rate for Payer: Qualcare PPO/HMO/WC	$31.73

GLIDESHEATH 6FR

Facility

$211.50

Service Code	HCPCS C1894
Hospital Charge Code	270686954N
Hospital Revenue Code	278
Min. Negotiated Rate	$31.73
Max. Negotiated Rate	$51.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.18
Rate for Payer: Qualcare PPO/HMO/WC	$31.73

GLIDESHEATH 6FR

Facility

$211.50

Service Code	HCPCS C1894
Hospital Charge Code	270686954S
Hospital Revenue Code	278
Min. Negotiated Rate	$31.73
Max. Negotiated Rate	$105.75
Rate for Payer: Aetna Commercial	$63.45
Rate for Payer: Aetna Medicare Advantage	$63.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.93
Rate for Payer: Cigna Commercial	$105.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.18
Rate for Payer: Qualcare PPO/HMO/WC	$31.73

GLIDESHEATH 6FR

Facility

$211.50

Service Code	HCPCS C1894
Hospital Charge Code	270686954S
Hospital Revenue Code	278
Min. Negotiated Rate	$31.73
Max. Negotiated Rate	$51.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.18
Rate for Payer: Qualcare PPO/HMO/WC	$31.73

Know your out-of-pocket cost for care.

All Charges