Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH SUPER W/O GW 8FR 11cm

Facility

$137.88

Service Code	HCPCS C1894
Hospital Charge Code	270637587
Hospital Revenue Code	278
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$33.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.68

SHEATH SUPER W/O GW 8FR 11cm

Facility

$51.73

Hospital Charge Code	270623288
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 W/O GW 8FR 11cm

Facility

$137.88

Service Code	HCPCS C1894
Hospital Charge Code	270637587
Hospital Revenue Code	278
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$68.94
Rate for Payer: Aetna Commercial	$41.36
Rate for Payer: Aetna Medicare Advantage	$41.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.16
Rate for Payer: Cigna Commercial	$68.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.68

SHEATH SUPER W/O GW 8FR 11cm

Facility

$51.73

Hospital Charge Code	270623288
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 8FR 25cm

Facility

$174.71

Service Code	HCPCS C1894
Hospital Charge Code	270631406
Hospital Revenue Code	278
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$87.36
Rate for Payer: Aetna Commercial	$52.41
Rate for Payer: Aetna Medicare Advantage	$52.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.55
Rate for Payer: Cigna Commercial	$87.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.28
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

SHEATH SUPER W/O GW 8FR 25cm

Facility

$174.71

Service Code	HCPCS C1894
Hospital Charge Code	270631406
Hospital Revenue Code	278
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.28
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

SHEATH SUPER W/O GW 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679
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 W/O GW 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679
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 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679N
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 W/O GW 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679N
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 9FR 11CM

Facility

$48.76

Hospital Charge Code	270637679C
Hospital Revenue Code	272
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$7.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

SHEATH SUPER W/O GW 9FR 11CM

Facility

$48.76

Hospital Charge Code	270637679C
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
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) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Commercial	$24.38

SHEATH SUPER W/O GW 9FR 25cm

Facility

$113.85

Service Code	HCPCS C1894
Hospital Charge Code	270626413
Hospital Revenue Code	278
Min. Negotiated Rate	$17.08
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) NJ Health	$22.77
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	$27.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH SUPER W/O GW 9FR 25cm

Facility

$113.85

Service Code	HCPCS C1894
Hospital Charge Code	270626413
Hospital Revenue Code	278
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$27.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH TIBIAL 30MM INTRAFIX

Facility

$1,475.00

Hospital Charge Code	270636750
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

SHEATH TIBIAL 30MM INTRAFIX

Facility

$1,475.00

Hospital Charge Code	270636750
Hospital Revenue Code	272
Min. Negotiated Rate	$191.75
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.75
Rate for Payer: Oxford Commercial	$737.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$737.50

SHEATH ULTRA 7FR 13 cm

Facility

$263.25

Service Code	HCPCS C1894
Hospital Charge Code	270664019
Hospital Revenue Code	278
Min. Negotiated Rate	$39.49
Max. Negotiated Rate	$63.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.71
Rate for Payer: Qualcare PPO/HMO/WC	$39.49

SHEATH ULTRA 7FR 13 cm

Facility

$263.25

Service Code	HCPCS C1894
Hospital Charge Code	270664019
Hospital Revenue Code	278
Min. Negotiated Rate	$39.49
Max. Negotiated Rate	$131.62
Rate for Payer: Aetna Commercial	$78.97
Rate for Payer: Aetna Medicare Advantage	$78.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.13
Rate for Payer: Cigna Commercial	$131.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.71
Rate for Payer: Qualcare PPO/HMO/WC	$39.49

SHEATH URETERAL ACCESS 12FR 28

Facility

$247.50

Hospital Charge Code	270639249
Hospital Revenue Code	272
Min. Negotiated Rate	$32.17
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$74.25
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.17
Rate for Payer: Oxford Commercial	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Commercial	$123.75

SHEATH URETERAL ACCESS 12FR 28

Facility

$247.50

Hospital Charge Code	270639249
Hospital Revenue Code	272
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$37.12
Rate for Payer: Qualcare PPO/HMO/WC	$37.12

SHEATH URETERAL ACCESS 12FRx20

Facility

$463.50

Hospital Charge Code	270625501
Hospital Revenue Code	272
Min. Negotiated Rate	$60.26
Max. Negotiated Rate	$231.75
Rate for Payer: Aetna Commercial	$139.05
Rate for Payer: Aetna Medicare Advantage	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.19
Rate for Payer: Cigna Commercial	$231.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Oxford Commercial	$231.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.53
Rate for Payer: UnitedHealthcare Commercial	$231.75

SHEATH URETERAL ACCESS 12FRx20

Facility

$463.50

Hospital Charge Code	270625501
Hospital Revenue Code	272
Min. Negotiated Rate	$69.53
Max. Negotiated Rate	$69.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.53

SHEATH URETERAL ACCESS 12FRx35

Facility

$247.50

Hospital Charge Code	270639289
Hospital Revenue Code	272
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$37.12
Rate for Payer: Qualcare PPO/HMO/WC	$37.12

SHEATH URETERAL ACCESS 12FRx35

Facility

$247.50

Hospital Charge Code	270639289
Hospital Revenue Code	272
Min. Negotiated Rate	$32.17
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$74.25
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.17
Rate for Payer: Oxford Commercial	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Commercial	$123.75

SHEATH W/HYDROPHILIC COAT 12FR

Facility

$1,300.00

Hospital Charge Code	270663540
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$390.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

Know your out-of-pocket cost for care.

All Charges