Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT ENDOSCOPY KIT BASIC

Facility

$250.00

Hospital Charge Code	270700164
Hospital Revenue Code	273
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

KIT ENEMA CLEANSING

Facility

$6.33

Hospital Charge Code	270649625
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.17
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.61
Rate for Payer: Cigna Commercial	$3.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.82
Rate for Payer: Oxford Commercial	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$3.17

KIT ENEMA CLEANSING

Facility

$6.33

Hospital Charge Code	270649625
Hospital Revenue Code	270
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

KIT ENTRY MEDI-TECH******

Facility

$374.00

Hospital Charge Code	1605815
Hospital Revenue Code	272
Min. Negotiated Rate	$48.62
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna Medicare Advantage	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.37
Rate for Payer: Cigna Commercial	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.62
Rate for Payer: Oxford Commercial	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.10
Rate for Payer: UnitedHealthcare Commercial	$187.00

KIT ENTRY MEDI-TECH******

Facility

$374.00

Hospital Charge Code	1605815
Hospital Revenue Code	272
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$56.10
Rate for Payer: Qualcare PPO/HMO/WC	$56.10

KIT ENTRY VENA CAVA 12F 50-350

Facility

$912.85

Hospital Charge Code	270601157
Hospital Revenue Code	272
Min. Negotiated Rate	$118.67
Max. Negotiated Rate	$456.43
Rate for Payer: Aetna Commercial	$273.86
Rate for Payer: Aetna Medicare Advantage	$273.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.78
Rate for Payer: Cigna Commercial	$456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.67
Rate for Payer: Oxford Commercial	$456.43
Rate for Payer: Qualcare PPO/HMO/WC	$136.93
Rate for Payer: UnitedHealthcare Commercial	$456.43

KIT ENTRY VENA CAVA 12F 50-350

Facility

$912.85

Hospital Charge Code	270601157
Hospital Revenue Code	272
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$136.93
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

KIT ENTRY VENA CAVA 12F 50350*

Facility

$160.00

Hospital Charge Code	1607191
Hospital Revenue Code	272
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$80.00

KIT ENTRY VENA CAVA 12F 50350*

Facility

$160.00

Hospital Charge Code	1607191
Hospital Revenue Code	272
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

KIT ENTRY VENA CAVA 12FR

Facility

$665.00

Hospital Charge Code	270605533
Hospital Revenue Code	272
Min. Negotiated Rate	$86.45
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.45
Rate for Payer: Oxford Commercial	$332.50
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Commercial	$332.50

KIT ENTRY VENA CAVA 12FR

Facility

$665.00

Hospital Charge Code	270605533
Hospital Revenue Code	272
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$99.75
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

KIT EPISTAXIS BALLOON CATH

Facility

$457.50

Hospital Charge Code	270677766
Hospital Revenue Code	272
Min. Negotiated Rate	$59.48
Max. Negotiated Rate	$228.75
Rate for Payer: Aetna Commercial	$137.25
Rate for Payer: Aetna Medicare Advantage	$137.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.66
Rate for Payer: Cigna Commercial	$228.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.48
Rate for Payer: Oxford Commercial	$228.75
Rate for Payer: Qualcare PPO/HMO/WC	$68.62
Rate for Payer: UnitedHealthcare Commercial	$228.75

KIT EPISTAXIS BALLOON CATH

Facility

$457.50

Hospital Charge Code	270677766
Hospital Revenue Code	272
Min. Negotiated Rate	$68.62
Max. Negotiated Rate	$68.62
Rate for Payer: Qualcare PPO/HMO/WC	$68.62

KIT EPISTAXIS BALLOON CATH****

Facility

$115.00

Hospital Charge Code	8004301
Hospital Revenue Code	272
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

KIT EPISTAXIS BALLOON CATH****

Facility

$115.00

Hospital Charge Code	8004301
Hospital Revenue Code	272
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.95
Rate for Payer: Oxford Commercial	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$57.50

KIT EXTENSION

Facility

$3,475.00

Hospital Charge Code	270663407
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,042.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

KIT EXTENSION

Facility

$3,475.00

Hospital Charge Code	270663407
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

KIT EXTENSION 37082-40

Facility

$7,950.00

Hospital Charge Code	270639948
Hospital Revenue Code	272
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,192.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

KIT EXTENSION 37082-40

Facility

$7,950.00

Hospital Charge Code	270639948
Hospital Revenue Code	272
Min. Negotiated Rate	$1,033.50
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$2,385.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.50
Rate for Payer: Oxford Commercial	$3,975.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Commercial	$3,975.00

KIT F4:H19RESORABLE MIN BEAD

Facility

$3,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270656808
Hospital Revenue Code	278
Min. Negotiated Rate	$523.50
Max. Negotiated Rate	$1,745.00
Rate for Payer: Aetna Commercial	$1,047.00
Rate for Payer: Aetna Medicare Advantage	$1,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$889.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$889.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$698.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$889.95
Rate for Payer: Cigna Commercial	$1,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$844.58
Rate for Payer: Qualcare PPO/HMO/WC	$523.50

KIT F4:H19RESORABLE MIN BEAD

Facility

$3,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270656808
Hospital Revenue Code	278
Min. Negotiated Rate	$523.50
Max. Negotiated Rate	$844.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$698.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$844.58
Rate for Payer: Qualcare PPO/HMO/WC	$523.50

KIT FDL IMPLANT SYSTEM 4.75MM

Facility

$7,475.00

Hospital Charge Code	270690930
Hospital Revenue Code	272
Min. Negotiated Rate	$971.75
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.75
Rate for Payer: Oxford Commercial	$3,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$3,737.50

KIT FDL IMPLANT SYSTEM 4.75MM

Facility

$7,475.00

Hospital Charge Code	270690930
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

KIT FDL IMPLANT SYSTEM 5.5MM

Facility

$7,475.00

Hospital Charge Code	270690929
Hospital Revenue Code	272
Min. Negotiated Rate	$971.75
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.75
Rate for Payer: Oxford Commercial	$3,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$3,737.50

KIT FDL IMPLANT SYSTEM 5.5MM

Facility

$7,475.00

Hospital Charge Code	270690929
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

Know your out-of-pocket cost for care.

All Charges