Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$240.00

Service Code	HCPCS C1894
Hospital Charge Code	270675360N
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$240.00

Service Code	HCPCS C1894
Hospital Charge Code	270675360N
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$302.50

Service Code	HCPCS C1894
Hospital Charge Code	270675360
Hospital Revenue Code	278
Min. Negotiated Rate	$45.38
Max. Negotiated Rate	$151.25
Rate for Payer: Aetna Commercial	$90.75
Rate for Payer: Aetna Medicare Advantage	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.14
Rate for Payer: Cigna Commercial	$151.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.38

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$302.50

Service Code	HCPCS C1894
Hospital Charge Code	270675360
Hospital Revenue Code	278
Min. Negotiated Rate	$45.38
Max. Negotiated Rate	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.38

SHEATH STABILIZATION DEVICE

Facility

$1,895.00

Hospital Charge Code	2709003701
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975N
Hospital Revenue Code	271
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$26.85
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.63
Rate for Payer: Oxford Commercial	$44.75
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$44.75

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975S
Hospital Revenue Code	271
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$26.85
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.63
Rate for Payer: Oxford Commercial	$44.75
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$44.75

SHEATH STABILIZATION DEVICE

Facility

$1,895.00

Hospital Charge Code	2709003701
Hospital Revenue Code	272
Min. Negotiated Rate	$246.35
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$568.50
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.35
Rate for Payer: Oxford Commercial	$947.50
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$947.50

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975N
Hospital Revenue Code	271
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975
Hospital Revenue Code	271
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$26.85
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.63
Rate for Payer: Oxford Commercial	$44.75
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$44.75

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975
Hospital Revenue Code	271
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975S
Hospital Revenue Code	271
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

SHEATH STAPLER 45

Facility

$100.00

Hospital Charge Code	270666137
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

SHEATH STAPLER 45

Facility

$100.00

Hospital Charge Code	270666137
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

SHEATH SUPER 12FR

Facility

$51.73

Hospital Charge Code	270660036
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

SHEATH SUPER 12FR

Facility

$51.73

Hospital Charge Code	270660036
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$25.86
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: Aetna Medicare Advantage	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.19
Rate for Payer: Cigna Commercial	$25.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

SHEATH SUPER 5FR 11cm .035

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270623265
Hospital Revenue Code	278
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna Medicare Advantage	$14.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

SHEATH SUPER 5FR 11cm .035

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270623265
Hospital Revenue Code	278
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$11.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

SHEATH SUPER PINNACLE 12FR

Facility

$51.73

Hospital Charge Code	270660039
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

SHEATH SUPER PINNACLE 12FR

Facility

$51.73

Hospital Charge Code	270660039
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$25.86
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: Aetna Medicare Advantage	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.19
Rate for Payer: Cigna Commercial	$25.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316O
Hospital Revenue Code	272
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$17.08
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316
Hospital Revenue Code	272
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$17.08
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316
Hospital Revenue Code	272
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$34.16
Rate for Payer: Aetna Medicare Advantage	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.03
Rate for Payer: Cigna Commercial	$56.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.80
Rate for Payer: Oxford Commercial	$56.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.08
Rate for Payer: UnitedHealthcare Commercial	$56.92

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316O
Hospital Revenue Code	272
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$34.16
Rate for Payer: Aetna Medicare Advantage	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.03
Rate for Payer: Cigna Commercial	$56.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.80
Rate for Payer: Oxford Commercial	$56.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.08
Rate for Payer: UnitedHealthcare Commercial	$56.92

SHEATH SUPER W/O GW 4FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270637756
Hospital Revenue Code	278
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$11.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

Know your out-of-pocket cost for care.

All Charges