Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH ACCU KIT INTERM 18GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699051
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$174.00
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 18GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699051
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$174.00
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$174.00
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACUTHERM DECOM 7210442

Facility

$8,975.00

Hospital Charge Code	270640709
Hospital Revenue Code	272
Min. Negotiated Rate	$1,166.75
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$2,692.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,166.75
Rate for Payer: Oxford Commercial	$4,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Commercial	$4,487.50

CATH ACUTHERM DECOM 7210442

Facility

$8,975.00

Hospital Charge Code	270640709
Hospital Revenue Code	272
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$1,346.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

CATH AD BEREN 5F .038 10722105

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623924
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH AD BEREN 5F .038 10722105

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623924
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH AD CARD 5F .035 10732201

Facility

$147.00

Hospital Charge Code	270623313V
Hospital Revenue Code	278
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

CATH AD CARD 5F .035 10732201

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623313
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH AD CARD 5F .035 10732201

Facility

$147.00

Hospital Charge Code	270623313V
Hospital Revenue Code	278
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$35.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

CATH AD CARD 5F .035 10732201

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623313
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH AD CARD 5F .035 50722822

Facility

$89.65

Hospital Charge Code	270623312
Hospital Revenue Code	278
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.70
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

CATH AD CARD 5F .035 50722822

Facility

$89.65

Hospital Charge Code	270623312
Hospital Revenue Code	278
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$26.89
Rate for Payer: Aetna Medicare Advantage	$26.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.86
Rate for Payer: Cigna Commercial	$44.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.70
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

CATH AD CARD 5F .038 10732203

Facility

$94.45

Hospital Charge Code	270623923
Hospital Revenue Code	272
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$14.17

CATH AD CARD 5F .038 10732203

Facility

$94.45

Hospital Charge Code	270623923
Hospital Revenue Code	272
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$47.23
Rate for Payer: Aetna Commercial	$28.34
Rate for Payer: Aetna Medicare Advantage	$28.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.08
Rate for Payer: Cigna Commercial	$47.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.28
Rate for Payer: Oxford Commercial	$47.23
Rate for Payer: Qualcare PPO/HMO/WC	$14.17
Rate for Payer: UnitedHealthcare Commercial	$47.23

CATH AD CARD BERENS 10722104

Facility

$94.45

Hospital Charge Code	270623315
Hospital Revenue Code	272
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$14.17

CATH AD CARD BERENS 10722104

Facility

$94.45

Hospital Charge Code	270623315
Hospital Revenue Code	272
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$47.23
Rate for Payer: Aetna Commercial	$28.34
Rate for Payer: Aetna Medicare Advantage	$28.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.08
Rate for Payer: Cigna Commercial	$47.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.28
Rate for Payer: Oxford Commercial	$47.23
Rate for Payer: Qualcare PPO/HMO/WC	$14.17
Rate for Payer: UnitedHealthcare Commercial	$47.23

CATH AD CARD COBRA 10719702

Facility

$94.45

Hospital Charge Code	270623314
Hospital Revenue Code	272
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$47.23
Rate for Payer: Aetna Commercial	$28.34
Rate for Payer: Aetna Medicare Advantage	$28.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.08
Rate for Payer: Cigna Commercial	$47.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.28
Rate for Payer: Oxford Commercial	$47.23
Rate for Payer: Qualcare PPO/HMO/WC	$14.17
Rate for Payer: UnitedHealthcare Commercial	$47.23

CATH AD CARD COBRA 10719702

Facility

$94.45

Hospital Charge Code	270623314
Hospital Revenue Code	272
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$14.17

CATH ADMIRAL XTREME 9x60x80

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270642305
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATH ADMIRAL XTREME 9x60x80

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270642305
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$210.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATH AL 1.5 6F 67003800

Facility

$277.70

Service Code	HCPCS C1887
Hospital Charge Code	270636312
Hospital Revenue Code	278
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.66

Know your out-of-pocket cost for care.

All Charges