Heights University Hospital

All Charges

Charge

Type

Setting

Price

PL 100 LEUKOCYTE REMVL FILTER

Facility

$573.65

Hospital Charge Code	8003352
Hospital Revenue Code	270
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$86.05
Rate for Payer: Qualcare PPO/HMO/WC	$86.05

PL 100 LEUKOCYTE REMVL FILTER

Facility

$573.65

Hospital Charge Code	8003352
Hospital Revenue Code	270
Min. Negotiated Rate	$74.57
Max. Negotiated Rate	$286.82
Rate for Payer: Aetna Commercial	$172.09
Rate for Payer: Aetna Medicare Advantage	$172.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.28
Rate for Payer: Cigna Commercial	$286.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.57
Rate for Payer: Oxford Commercial	$286.82
Rate for Payer: Qualcare PPO/HMO/WC	$86.05
Rate for Payer: UnitedHealthcare Commercial	$286.82

PL 50 LEUKOCYTE REMOVAL FILTER

Facility

$328.85

Hospital Charge Code	8003360
Hospital Revenue Code	270
Min. Negotiated Rate	$49.33
Max. Negotiated Rate	$49.33
Rate for Payer: Qualcare PPO/HMO/WC	$49.33

PL 50 LEUKOCYTE REMOVAL FILTER

Facility

$328.85

Hospital Charge Code	8003360
Hospital Revenue Code	270
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$164.43
Rate for Payer: Aetna Commercial	$98.66
Rate for Payer: Aetna Medicare Advantage	$98.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.86
Rate for Payer: Cigna Commercial	$164.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.75
Rate for Payer: Oxford Commercial	$164.43
Rate for Payer: Qualcare PPO/HMO/WC	$49.33
Rate for Payer: UnitedHealthcare Commercial	$164.43

PLA 4HOLE LT PRO DOR 234801004

Facility

$3,474.15

Hospital Charge Code	270639859
Hospital Revenue Code	278
Min. Negotiated Rate	$521.12
Max. Negotiated Rate	$840.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$694.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.74
Rate for Payer: Qualcare PPO/HMO/WC	$521.12

PLA 4HOLE LT PRO DOR 234801004

Facility

$3,474.15

Hospital Charge Code	270639859
Hospital Revenue Code	278
Min. Negotiated Rate	$521.12
Max. Negotiated Rate	$1,737.08
Rate for Payer: Aetna Commercial	$1,042.24
Rate for Payer: Aetna Medicare Advantage	$1,042.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$694.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.91
Rate for Payer: Cigna Commercial	$1,737.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.74
Rate for Payer: Qualcare PPO/HMO/WC	$521.12

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	5100014
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	5100014
Hospital Revenue Code	361
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$222.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	74110003
Hospital Revenue Code	361
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$222.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	74110003
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

PLACE CATH 1ST ORDER THORA

Facility

$1,214.10

Service Code	HCPCS 36215
Hospital Charge Code	5100370
Hospital Revenue Code	761
Min. Negotiated Rate	$157.83
Max. Negotiated Rate	$607.05
Rate for Payer: Aetna Commercial	$364.23
Rate for Payer: Aetna Medicare Advantage	$364.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.60
Rate for Payer: Cigna Commercial	$203.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.83
Rate for Payer: Oxford Commercial	$607.05
Rate for Payer: Qualcare PPO/HMO/WC	$182.12
Rate for Payer: UnitedHealthcare Commercial	$607.05

PLACE CATH 1ST ORDER THORA

Facility

$1,214.10

Service Code	HCPCS 36215
Hospital Charge Code	5100370
Hospital Revenue Code	761
Min. Negotiated Rate	$182.12
Max. Negotiated Rate	$182.12
Rate for Payer: Qualcare PPO/HMO/WC	$182.12

PLACE CATH 2ND ORDER ABD L EXT

Facility

$331.55

Service Code	HCPCS 36246
Hospital Charge Code	5100480
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

PLACE CATH 2ND ORDER ABD L EXT

Facility

$331.55

Service Code	HCPCS 36246
Hospital Charge Code	5100480
Hospital Revenue Code	761
Min. Negotiated Rate	$43.10
Max. Negotiated Rate	$237.81
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$237.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.10
Rate for Payer: Oxford Commercial	$165.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$165.78

PLACE CATH 3RD ORD ABD OR LEX

Facility

$331.55

Service Code	HCPCS 36247
Hospital Charge Code	5100460
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

PLACE CATH 3RD ORD ABD OR LEX

Facility

$331.55

Service Code	HCPCS 36247
Hospital Charge Code	5100460
Hospital Revenue Code	761
Min. Negotiated Rate	$43.10
Max. Negotiated Rate	$278.15
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$278.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.10
Rate for Payer: Oxford Commercial	$165.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$165.78

PLACE CATH 3RD THOR/BRACHCEPH

Facility

$331.55

Service Code	HCPCS 36217
Hospital Charge Code	5100331
Hospital Revenue Code	761
Min. Negotiated Rate	$43.10
Max. Negotiated Rate	$325.31
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$325.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.10
Rate for Payer: Oxford Commercial	$165.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$165.78

PLACE CATH 3RD THOR/BRACHCEPH

Facility

$331.55

Service Code	HCPCS 36217
Hospital Charge Code	5100331
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

PLACE CATH CAROTD ART

Facility

$21,387.78

Service Code	HCPCS 36224
Hospital Charge Code	366836224
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,416.33
Rate for Payer: Aetna Medicare Advantage	$6,416.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,453.88
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,780.41
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,208.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PLACE CATH CAROTD ART

Facility

$21,387.78

Service Code	HCPCS 36224
Hospital Charge Code	411036224
Hospital Revenue Code	361
Min. Negotiated Rate	$3,208.17
Max. Negotiated Rate	$3,208.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,208.17

PLACE CATH CAROTD ART

Facility

$21,387.78

Service Code	HCPCS 36224
Hospital Charge Code	366836224
Hospital Revenue Code	361
Min. Negotiated Rate	$3,208.17
Max. Negotiated Rate	$3,208.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,208.17

PLACE CATH CAROTD ART

Facility

$21,387.78

Service Code	HCPCS 36224
Hospital Charge Code	411036224
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,416.33
Rate for Payer: Aetna Medicare Advantage	$6,416.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,453.88
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,780.41
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,208.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PLACE CATH CAROTD ART BI

Facility

$38,442.70

Service Code	HCPCS 3622450
Hospital Charge Code	411036224B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$19,221.35
Rate for Payer: Aetna Commercial	$11,532.81
Rate for Payer: Aetna Medicare Advantage	$11,532.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,802.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,802.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,802.89
Rate for Payer: Cigna Commercial	$19,221.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,997.55
Rate for Payer: Qualcare PPO/HMO/WC	$5,766.40

PLACE CATH CAROTD ART BI

Facility

$38,442.70

Service Code	HCPCS 3622450
Hospital Charge Code	411036224B
Hospital Revenue Code	361
Min. Negotiated Rate	$5,766.40
Max. Negotiated Rate	$5,766.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,766.40

PLACE CATH CAROTID ART

Facility

$21,387.78

Service Code	HCPCS 36224
Hospital Charge Code	5100811
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,416.33
Rate for Payer: Aetna Medicare Advantage	$6,416.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,453.88
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,780.41
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,208.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges