Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT RESORABLE MIN BEAD

Facility

$3,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270645042
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 RETRACTOR 3308L

Facility

$662.45

Hospital Charge Code	270600268
Hospital Revenue Code	272
Min. Negotiated Rate	$99.37
Max. Negotiated Rate	$99.37
Rate for Payer: Qualcare PPO/HMO/WC	$99.37

KIT RETRACTOR 3308L

Facility

$662.45

Hospital Charge Code	270600268
Hospital Revenue Code	272
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$331.23
Rate for Payer: Aetna Commercial	$198.74
Rate for Payer: Aetna Medicare Advantage	$198.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.92
Rate for Payer: Cigna Commercial	$331.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.12
Rate for Payer: Oxford Commercial	$331.23
Rate for Payer: Qualcare PPO/HMO/WC	$99.37
Rate for Payer: UnitedHealthcare Commercial	$331.23

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363S
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363C
Hospital Revenue Code	272
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$1,125.00

KIT RETRIEVAL SNARE

Facility

$2,500.00

Hospital Charge Code	270671363N
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363C
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT RETRIEVAL SNARE

Facility

$2,500.00

Hospital Charge Code	270671363N
Hospital Revenue Code	272
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$1,250.00

KIT RETRIEVAL SNARE

Facility

$2,250.00

Hospital Charge Code	270671363S
Hospital Revenue Code	272
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$1,125.00

KIT REVISION STERILE 355010

Facility

$1,438.45

Hospital Charge Code	270632708
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$719.23
Rate for Payer: Aetna Commercial	$431.54
Rate for Payer: Aetna Medicare Advantage	$431.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.80
Rate for Payer: Cigna Commercial	$719.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.00
Rate for Payer: Oxford Commercial	$719.23
Rate for Payer: Qualcare PPO/HMO/WC	$215.77
Rate for Payer: UnitedHealthcare Commercial	$719.23

KIT REVISION STERILE 355010

Facility

$1,438.45

Hospital Charge Code	270632708
Hospital Revenue Code	272
Min. Negotiated Rate	$215.77
Max. Negotiated Rate	$215.77
Rate for Payer: Qualcare PPO/HMO/WC	$215.77

KIT RIGHT HEART

Facility

$750.00

Hospital Charge Code	270678577N
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

KIT RIGHT HEART

Facility

$75.00

Hospital Charge Code	270678577
Hospital Revenue Code	272
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

KIT RIGHT HEART

Facility

$750.00

Hospital Charge Code	270678577N
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$375.00

KIT RIGHT HEART

Facility

$75.00

Hospital Charge Code	270678577
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

KIT RIGHT HEART (CUSTOM)

Facility

$112.50

Hospital Charge Code	2709002684
Hospital Revenue Code	272
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

KIT RIGHT HEART (CUSTOM)

Facility

$112.50

Hospital Charge Code	2709002684
Hospital Revenue Code	272
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$33.75
Rate for Payer: Aetna Medicare Advantage	$33.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.69
Rate for Payer: Cigna Commercial	$56.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.62
Rate for Payer: Oxford Commercial	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$16.88
Rate for Payer: UnitedHealthcare Commercial	$56.25

KIT RIOLCENT WILSON FRAME 5322

Facility

$133.79

Hospital Charge Code	270627620
Hospital Revenue Code	272
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.07

KIT RIOLCENT WILSON FRAME 5322

Facility

$133.79

Hospital Charge Code	270627620
Hospital Revenue Code	272
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$66.89
Rate for Payer: Aetna Commercial	$40.14
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.12
Rate for Payer: Cigna Commercial	$66.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.39
Rate for Payer: Oxford Commercial	$66.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.07
Rate for Payer: UnitedHealthcare Commercial	$66.89

KIT SAFESHEATH II 7FR

Facility

$292.50

Hospital Charge Code	270676908S
Hospital Revenue Code	272
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

KIT SAFESHEATH II 7FR

Facility

$292.50

Hospital Charge Code	270676908S
Hospital Revenue Code	272
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$87.75
Rate for Payer: Aetna Medicare Advantage	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.02
Rate for Payer: Oxford Commercial	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$43.88
Rate for Payer: UnitedHealthcare Commercial	$146.25

KIT SAFESHEATH II 7FR

Facility

$292.50

Hospital Charge Code	270676908
Hospital Revenue Code	272
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$87.75
Rate for Payer: Aetna Medicare Advantage	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.02
Rate for Payer: Oxford Commercial	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$43.88
Rate for Payer: UnitedHealthcare Commercial	$146.25

KIT SAFESHEATH II 7FR

Facility

$292.50

Hospital Charge Code	270676908
Hospital Revenue Code	272
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

KIT SAFESHEATH II 9FR

Facility

$292.50

Hospital Charge Code	270676907
Hospital Revenue Code	272
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$87.75
Rate for Payer: Aetna Medicare Advantage	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.02
Rate for Payer: Oxford Commercial	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$43.88
Rate for Payer: UnitedHealthcare Commercial	$146.25

KIT SAFESHEATH II 9FR

Facility

$292.50

Hospital Charge Code	270676907
Hospital Revenue Code	272
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

Know your out-of-pocket cost for care.

All Charges