Heights University Hospital

All Charges

Charge

Type

Setting

Price

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	7411115
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	7411115
Hospital Revenue Code	361
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	366836247R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621750
Hospital Charge Code	7411093
Hospital Revenue Code	361
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.18
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621750
Hospital Charge Code	7411093
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	7411095
Hospital Revenue Code	361
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.18
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	7411095
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	7411097
Hospital Revenue Code	361
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.18
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	7411097
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PLEDGET 3 X 7 MM SOFT

Facility

$46.60

Hospital Charge Code	270666831
Hospital Revenue Code	278
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$23.30
Rate for Payer: Aetna Commercial	$13.98
Rate for Payer: Aetna Medicare Advantage	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.88
Rate for Payer: Cigna Commercial	$23.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.99

PLEDGET 3 X 7 MM SOFT

Facility

$46.60

Hospital Charge Code	270666831
Hospital Revenue Code	278
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.99

PLEDGET FELT 1 X 1

Facility

$210.53

Hospital Charge Code	270669534
Hospital Revenue Code	272
Min. Negotiated Rate	$27.37
Max. Negotiated Rate	$105.27
Rate for Payer: Aetna Commercial	$63.16
Rate for Payer: Aetna Medicare Advantage	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.69
Rate for Payer: Cigna Commercial	$105.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.37
Rate for Payer: Oxford Commercial	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$31.58
Rate for Payer: UnitedHealthcare Commercial	$105.27

PLEDGET FELT 1 X 1

Facility

$210.53

Hospital Charge Code	270669534
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$31.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.58

PLEDGET FIRM TFE 1/4x1/8

Facility

$14.62

Hospital Charge Code	270671495
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

PLEDGET FIRM TFE 1/4x1/8

Facility

$14.62

Hospital Charge Code	270671495
Hospital Revenue Code	272
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$7.31
Rate for Payer: Aetna Commercial	$4.39
Rate for Payer: Aetna Medicare Advantage	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.73
Rate for Payer: Cigna Commercial	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.90
Rate for Payer: Oxford Commercial	$7.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$7.31

PLEDGET PRE PUNCH MM ST

Facility

$17.43

Hospital Charge Code	270661057
Hospital Revenue Code	272
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$8.71
Rate for Payer: Aetna Commercial	$5.23
Rate for Payer: Aetna Medicare Advantage	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.44
Rate for Payer: Cigna Commercial	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.27
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.61
Rate for Payer: UnitedHealthcare Commercial	$8.71

PLEDGET PRE PUNCH MM ST

Facility

$17.43

Hospital Charge Code	270661057
Hospital Revenue Code	272
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.61

PLEDGETS FELT 8MMX8MM 007972

Facility

$5.50

Service Code	HCPCS C1713
Hospital Charge Code	270634715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$1.65
Rate for Payer: Aetna Medicare Advantage	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.40
Rate for Payer: Cigna Commercial	$2.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

PLEDGETS FELT 8MMX8MM 007972

Facility

$5.50

Service Code	HCPCS C1713
Hospital Charge Code	270634715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

PLEDGET TEFLON 6 4.5 1MM

Facility

$9.65

Hospital Charge Code	270601210
Hospital Revenue Code	278
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

PLEDGET TEFLON 6 4.5 1MM

Facility

$9.65

Hospital Charge Code	270601210
Hospital Revenue Code	278
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

PLEDGET TEFLON 6 4.5 1MM *****

Facility

$55.00

Hospital Charge Code	1604321
Hospital Revenue Code	278
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$13.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

PLEDGET TEFLON 6 4.5 1MM *****

Facility

$55.00

Hospital Charge Code	1604321
Hospital Revenue Code	278
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$16.50
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

PLEDGET TFE SOFT 1/4x1/8

Facility

$13.23

Hospital Charge Code	270671496
Hospital Revenue Code	272
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$6.62
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.72
Rate for Payer: Oxford Commercial	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$6.62

PLEDGET TFE SOFT 1/4x1/8

Facility

$13.23

Hospital Charge Code	270671496
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

Know your out-of-pocket cost for care.

All Charges