Heights University Hospital

All Charges

Charge

Type

Setting

Price

BASKET RX LITHOTRIPTER 2.5c

Facility

$1,371.55

Service Code	HCPCS C1727
Hospital Charge Code	270627946
Hospital Revenue Code	278
Min. Negotiated Rate	$205.73
Max. Negotiated Rate	$685.77
Rate for Payer: Aetna Commercial	$411.46
Rate for Payer: Aetna Medicare Advantage	$411.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$274.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.75
Rate for Payer: Cigna Commercial	$685.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.92
Rate for Payer: Qualcare PPO/HMO/WC	$205.73

BASKET RX LITHOTRIPTER 2.5c

Facility

$1,371.55

Service Code	HCPCS C1727
Hospital Charge Code	270627946
Hospital Revenue Code	278
Min. Negotiated Rate	$205.73
Max. Negotiated Rate	$331.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$274.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.92
Rate for Payer: Qualcare PPO/HMO/WC	$205.73

BASKET RX LITHOTRIPTER 3.0c

Facility

$1,391.00

Service Code	HCPCS C1727
Hospital Charge Code	270642025
Hospital Revenue Code	278
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$695.50
Rate for Payer: Aetna Commercial	$417.30
Rate for Payer: Aetna Medicare Advantage	$417.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.70
Rate for Payer: Cigna Commercial	$695.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

BASKET RX LITHOTRIPTER 3.0c

Facility

$1,391.00

Service Code	HCPCS C1727
Hospital Charge Code	270642025
Hospital Revenue Code	278
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$336.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

BASKET SEGURA 2.4F .80MMX90CM

Facility

$1,585.55

Service Code	HCPCS C1773
Hospital Charge Code	270697142
Hospital Revenue Code	278
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$383.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.70
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET SEGURA 2.4F .80MMX90CM

Facility

$1,585.55

Service Code	HCPCS C1773
Hospital Charge Code	270697142
Hospital Revenue Code	278
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$475.67
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.70
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET SEGURA 4.5FR

Facility

$765.00

Hospital Charge Code	270655486
Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

BASKET SEGURA 4.5FR

Facility

$765.00

Hospital Charge Code	270655486
Hospital Revenue Code	272
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.45
Rate for Payer: Oxford Commercial	$382.50
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$382.50

BASKET SEGURA MINI 2.4F 310105

Facility

$1,585.55

Hospital Charge Code	270612432
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET SEGURA MINI 2.4F 310105

Facility

$1,585.55

Hospital Charge Code	270612432
Hospital Revenue Code	272
Min. Negotiated Rate	$206.12
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$475.67
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.12
Rate for Payer: Oxford Commercial	$792.77
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Commercial	$792.77

BASKET STONE 3FR 60CM

Facility

$918.40

Hospital Charge Code	270658596
Hospital Revenue Code	272
Min. Negotiated Rate	$119.39
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$275.52
Rate for Payer: Aetna Medicare Advantage	$275.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.19
Rate for Payer: Cigna Commercial	$459.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.39
Rate for Payer: Oxford Commercial	$459.20
Rate for Payer: Qualcare PPO/HMO/WC	$137.76
Rate for Payer: UnitedHealthcare Commercial	$459.20

BASKET STONE 3FR 60CM

Facility

$918.40

Hospital Charge Code	270658596
Hospital Revenue Code	272
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$137.76
Rate for Payer: Qualcare PPO/HMO/WC	$137.76

BASKET STONE RETRIEVAL 7FR

Facility

$1,072.50

Hospital Charge Code	270655481
Hospital Revenue Code	272
Min. Negotiated Rate	$139.43
Max. Negotiated Rate	$536.25
Rate for Payer: Aetna Commercial	$321.75
Rate for Payer: Aetna Medicare Advantage	$321.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.49
Rate for Payer: Cigna Commercial	$536.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.43
Rate for Payer: Oxford Commercial	$536.25
Rate for Payer: Qualcare PPO/HMO/WC	$160.88
Rate for Payer: UnitedHealthcare Commercial	$536.25

BASKET STONE RETRIEVAL 7FR

Facility

$1,072.50

Hospital Charge Code	270655481
Hospital Revenue Code	272
Min. Negotiated Rate	$160.88
Max. Negotiated Rate	$160.88
Rate for Payer: Qualcare PPO/HMO/WC	$160.88

BASKET STZ STN FX 3FR 11276NB

Facility

$1,328.85

Hospital Charge Code	270601037
Hospital Revenue Code	272
Min. Negotiated Rate	$199.33
Max. Negotiated Rate	$199.33
Rate for Payer: Qualcare PPO/HMO/WC	$199.33

BASKET STZ STN FX 3FR 11276NB

Facility

$1,328.85

Hospital Charge Code	270601037
Hospital Revenue Code	272
Min. Negotiated Rate	$172.75
Max. Negotiated Rate	$664.42
Rate for Payer: Aetna Commercial	$398.65
Rate for Payer: Aetna Medicare Advantage	$398.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.86
Rate for Payer: Cigna Commercial	$664.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.75
Rate for Payer: Oxford Commercial	$664.42
Rate for Payer: Qualcare PPO/HMO/WC	$199.33
Rate for Payer: UnitedHealthcare Commercial	$664.42

BASKET TIPLESS 115CM 3 WIRE

Facility

$1,093.50

Hospital Charge Code	270690428
Hospital Revenue Code	272
Min. Negotiated Rate	$164.03
Max. Negotiated Rate	$164.03
Rate for Payer: Qualcare PPO/HMO/WC	$164.03

BASKET TIPLESS 115CM 3 WIRE

Facility

$1,093.50

Hospital Charge Code	270690428
Hospital Revenue Code	272
Min. Negotiated Rate	$142.16
Max. Negotiated Rate	$546.75
Rate for Payer: Aetna Commercial	$328.05
Rate for Payer: Aetna Medicare Advantage	$328.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.84
Rate for Payer: Cigna Commercial	$546.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.16
Rate for Payer: Oxford Commercial	$546.75
Rate for Payer: Qualcare PPO/HMO/WC	$164.03
Rate for Payer: UnitedHealthcare Commercial	$546.75

BASKETTRAPEZOID 1.5cmx.035

Facility

$1,353.40

Hospital Charge Code	270672229
Hospital Revenue Code	272
Min. Negotiated Rate	$203.01
Max. Negotiated Rate	$203.01
Rate for Payer: Qualcare PPO/HMO/WC	$203.01

BASKETTRAPEZOID 1.5cmx.035

Facility

$1,353.40

Hospital Charge Code	270672229
Hospital Revenue Code	272
Min. Negotiated Rate	$175.94
Max. Negotiated Rate	$676.70
Rate for Payer: Aetna Commercial	$406.02
Rate for Payer: Aetna Medicare Advantage	$406.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.12
Rate for Payer: Cigna Commercial	$676.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.94
Rate for Payer: Oxford Commercial	$676.70
Rate for Payer: Qualcare PPO/HMO/WC	$203.01
Rate for Payer: UnitedHealthcare Commercial	$676.70

BASKET TRAPEZOID 2.0cmx.035

Facility

$1,353.40

Hospital Charge Code	270627940
Hospital Revenue Code	272
Min. Negotiated Rate	$175.94
Max. Negotiated Rate	$676.70
Rate for Payer: Aetna Commercial	$406.02
Rate for Payer: Aetna Medicare Advantage	$406.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.12
Rate for Payer: Cigna Commercial	$676.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.94
Rate for Payer: Oxford Commercial	$676.70
Rate for Payer: Qualcare PPO/HMO/WC	$203.01
Rate for Payer: UnitedHealthcare Commercial	$676.70

BASKET TRAPEZOID 2.0cmx.035

Facility

$1,353.40

Hospital Charge Code	270627940
Hospital Revenue Code	272
Min. Negotiated Rate	$203.01
Max. Negotiated Rate	$203.01
Rate for Payer: Qualcare PPO/HMO/WC	$203.01

BASKET ZERO TIP 3.0FX120CM

Facility

$1,878.95

Hospital Charge Code	270698291
Hospital Revenue Code	272
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$281.84
Rate for Payer: Qualcare PPO/HMO/WC	$281.84

BASKET ZERO TIP 3.0FX120CM

Facility

$1,878.95

Hospital Charge Code	270698291
Hospital Revenue Code	272
Min. Negotiated Rate	$244.26
Max. Negotiated Rate	$939.48
Rate for Payer: Aetna Commercial	$563.68
Rate for Payer: Aetna Medicare Advantage	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.13
Rate for Payer: Cigna Commercial	$939.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.26
Rate for Payer: Oxford Commercial	$939.48
Rate for Payer: Qualcare PPO/HMO/WC	$281.84
Rate for Payer: UnitedHealthcare Commercial	$939.48

BASKET ZERO TIP 3.0X90CM

Facility

$1,875.00

Hospital Charge Code	270698290
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.75
Rate for Payer: Oxford Commercial	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Commercial	$937.50

Know your out-of-pocket cost for care.

All Charges