Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH EMBOLECT D6 50CM 160246F

Facility

$2,493.65

Service Code	HCPCS C1757
Hospital Charge Code	270601078
Hospital Revenue Code	278
Min. Negotiated Rate	$374.05
Max. Negotiated Rate	$1,246.83
Rate for Payer: Aetna Commercial	$748.10
Rate for Payer: Aetna Medicare Advantage	$748.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.88
Rate for Payer: Cigna Commercial	$1,246.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.46
Rate for Payer: Qualcare PPO/HMO/WC	$374.05

CATH EMBOLECT D6 50CM 160246F

Facility

$2,493.65

Service Code	HCPCS C1757
Hospital Charge Code	270601078
Hospital Revenue Code	278
Min. Negotiated Rate	$374.05
Max. Negotiated Rate	$603.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.46
Rate for Payer: Qualcare PPO/HMO/WC	$374.05

CATH EMBOLECT D8 5FR 140808

Facility

$2,395.25

Hospital Charge Code	270601074
Hospital Revenue Code	272
Min. Negotiated Rate	$359.29
Max. Negotiated Rate	$359.29
Rate for Payer: Qualcare PPO/HMO/WC	$359.29

CATH EMBOLECT D8 5FR 140808

Facility

$2,395.25

Hospital Charge Code	270601074
Hospital Revenue Code	272
Min. Negotiated Rate	$311.38
Max. Negotiated Rate	$1,197.62
Rate for Payer: Aetna Commercial	$718.58
Rate for Payer: Aetna Medicare Advantage	$718.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$610.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$610.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$610.79
Rate for Payer: Cigna Commercial	$1,197.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.38
Rate for Payer: Oxford Commercial	$1,197.62
Rate for Payer: Qualcare PPO/HMO/WC	$359.29
Rate for Payer: UnitedHealthcare Commercial	$1,197.62

CATH EMBOLECT FOGARTY 4FR 40cm

Facility

$272.90

Hospital Charge Code	270651780
Hospital Revenue Code	272
Min. Negotiated Rate	$35.48
Max. Negotiated Rate	$136.45
Rate for Payer: Aetna Commercial	$81.87
Rate for Payer: Aetna Medicare Advantage	$81.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.59
Rate for Payer: Cigna Commercial	$136.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.48
Rate for Payer: Oxford Commercial	$136.45
Rate for Payer: Qualcare PPO/HMO/WC	$40.94
Rate for Payer: UnitedHealthcare Commercial	$136.45

CATH EMBOLECT FOGARTY 4FR 40cm

Facility

$272.90

Hospital Charge Code	270651780
Hospital Revenue Code	272
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$40.94
Rate for Payer: Qualcare PPO/HMO/WC	$40.94

CATH EMBOLECTMY 3F 6x80 165138

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631115
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$116.08
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECTMY 3F 6x80 165138

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631115
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECTOMY 4FR.10MMx40cm

Facility

$360.00

Hospital Charge Code	270631116
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$108.00
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.12
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

CATH EMBOLECTOMY 4FR.10MMx40cm

Facility

$360.00

Hospital Charge Code	270631116
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.12
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

CATH EMBOLECTOMY 5FR 1651-58

Facility

$386.95

Hospital Charge Code	270631119
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECTOMY 5FR 1651-58

Facility

$386.95

Hospital Charge Code	270631119
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$116.08
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECTOMY 7FR

Facility

$225.00

Hospital Charge Code	270654345
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CATH EMBOLECTOMY 7FR

Facility

$225.00

Hospital Charge Code	270654345
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CATH EMBOLECT PYTH 4F 5MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698568
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$298.50
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 4F 5MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698568
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F11MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698570
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$298.50
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F11MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698570
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F 9MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698569
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F 9MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698569
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$298.50
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLETOMY 3F 6x40 165134

Facility

$386.95

Hospital Charge Code	270631114
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$193.47
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: Aetna Commercial	$116.08
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64

CATH EMBOLETOMY 3F 6x40 165134

Facility

$386.95

Hospital Charge Code	270631114
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLTOMY 4F 10x80 165148

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631117
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$116.08
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLTOMY 4F 10x80 165148

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631117
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLTOMY 5F 12x40 165154

Facility

$386.95

Hospital Charge Code	270631118
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

Know your out-of-pocket cost for care.

All Charges