Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATHERTER BALLOON 4 X 20 X 80

Facility

$975.00

Service Code	HCPCS C1725
Hospital Charge Code	270658395
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

CATHERTER BALLOON 4 X 20 X 80

Facility

$975.00

Service Code	HCPCS C1725
Hospital Charge Code	270658395
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

CATHERTER BALLOON 6 X 40 X 120

Facility

$195.00

Hospital Charge Code	270658397
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CATHERTER BALLOON 6 X 40 X 120

Facility

$195.00

Hospital Charge Code	270658397
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CATHERTER BALLOON ADMIRAL XTRE

Facility

$900.00

Hospital Charge Code	2709002299
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHERTER BALLOON ADMIRAL XTRE

Facility

$900.00

Hospital Charge Code	2709002299
Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$450.00

CATH ESOPH DIL 10-12M 5835

Facility

$939.05

Service Code	HCPCS C1726
Hospital Charge Code	270608028
Hospital Revenue Code	278
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$469.52
Rate for Payer: Aetna Commercial	$281.71
Rate for Payer: Aetna Medicare Advantage	$281.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.46
Rate for Payer: Cigna Commercial	$469.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.86

CATH ESOPH DIL 10-12M 5835

Facility

$939.05

Service Code	HCPCS C1726
Hospital Charge Code	270608028
Hospital Revenue Code	278
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$227.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.86

CATH ESOPH DIL BAL 12-15M 5836

Facility

$4,201.00

Service Code	HCPCS C1726
Hospital Charge Code	270608025
Hospital Revenue Code	278
Min. Negotiated Rate	$630.15
Max. Negotiated Rate	$1,016.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.64
Rate for Payer: Qualcare PPO/HMO/WC	$630.15

CATH ESOPH DIL BAL 12-15M 5836

Facility

$4,201.00

Service Code	HCPCS C1726
Hospital Charge Code	270608025
Hospital Revenue Code	278
Min. Negotiated Rate	$630.15
Max. Negotiated Rate	$2,100.50
Rate for Payer: Aetna Commercial	$1,260.30
Rate for Payer: Aetna Medicare Advantage	$1,260.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.26
Rate for Payer: Cigna Commercial	$2,100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.64
Rate for Payer: Qualcare PPO/HMO/WC	$630.15

CATH ESOPH DIL BAL 15-18M 5837

Facility

$1,995.25

Service Code	HCPCS C1726
Hospital Charge Code	270608026
Hospital Revenue Code	278
Min. Negotiated Rate	$299.29
Max. Negotiated Rate	$997.62
Rate for Payer: Aetna Commercial	$598.58
Rate for Payer: Aetna Medicare Advantage	$598.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$399.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.79
Rate for Payer: Cigna Commercial	$997.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.85
Rate for Payer: Qualcare PPO/HMO/WC	$299.29

CATH ESOPH DIL BAL 15-18M 5837

Facility

$1,995.25

Service Code	HCPCS C1726
Hospital Charge Code	270608026
Hospital Revenue Code	278
Min. Negotiated Rate	$299.29
Max. Negotiated Rate	$482.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$399.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.85
Rate for Payer: Qualcare PPO/HMO/WC	$299.29

CATH ESOPH DIL ITE 8-10MM 5834

Facility

$1,995.25

Hospital Charge Code	270608027
Hospital Revenue Code	278
Min. Negotiated Rate	$299.29
Max. Negotiated Rate	$997.62
Rate for Payer: Aetna Commercial	$598.58
Rate for Payer: Aetna Medicare Advantage	$598.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$399.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.79
Rate for Payer: Cigna Commercial	$997.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.85
Rate for Payer: Qualcare PPO/HMO/WC	$299.29

CATH ESOPH DIL ITE 8-10MM 5834

Facility

$1,995.25

Hospital Charge Code	270608027
Hospital Revenue Code	278
Min. Negotiated Rate	$299.29
Max. Negotiated Rate	$482.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$399.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.85
Rate for Payer: Qualcare PPO/HMO/WC	$299.29

CATHET BALLN ADMIRAL XTREM

Facility

$200.00

Service Code	HCPCS C1725
Hospital Charge Code	270655027
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CATHET BALLN ADMIRAL XTREM

Facility

$200.00

Service Code	HCPCS C1725
Hospital Charge Code	270655027
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CATHETER 10FR. FELXIMA NEPHROS

Facility

$359.45

Hospital Charge Code	2706000661
Hospital Revenue Code	272
Min. Negotiated Rate	$46.73
Max. Negotiated Rate	$179.72
Rate for Payer: Aetna Commercial	$107.83
Rate for Payer: Aetna Medicare Advantage	$107.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.66
Rate for Payer: Cigna Commercial	$179.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.73
Rate for Payer: Oxford Commercial	$179.72
Rate for Payer: Qualcare PPO/HMO/WC	$53.92
Rate for Payer: UnitedHealthcare Commercial	$179.72

CATHETER 10FR. FELXIMA NEPHROS

Facility

$359.45

Hospital Charge Code	2706000661
Hospital Revenue Code	272
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$53.92
Rate for Payer: Qualcare PPO/HMO/WC	$53.92

CATHETER 120CM 5F SIM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270695065S
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER 120CM 5F SIM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270695065S
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER 125 CM SIMS

Facility

$625.00

Service Code	HCPCS C1887
Hospital Charge Code	270690857
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER 125 CM SIMS

Facility

$625.00

Service Code	HCPCS C1887
Hospital Charge Code	270690857
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER 12FR. FLEXIMA NEPHROS

Facility

$359.45

Hospital Charge Code	2706000660
Hospital Revenue Code	272
Min. Negotiated Rate	$46.73
Max. Negotiated Rate	$179.72
Rate for Payer: Aetna Commercial	$107.83
Rate for Payer: Aetna Medicare Advantage	$107.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.66
Rate for Payer: Cigna Commercial	$179.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.73
Rate for Payer: Oxford Commercial	$179.72
Rate for Payer: Qualcare PPO/HMO/WC	$53.92
Rate for Payer: UnitedHealthcare Commercial	$179.72

CATHETER 12FR. FLEXIMA NEPHROS

Facility

$359.45

Hospital Charge Code	2706000660
Hospital Revenue Code	272
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$53.92
Rate for Payer: Qualcare PPO/HMO/WC	$53.92

CATHETER 12 FR HIGH 20 CM

Facility

$2,647.60

Hospital Charge Code	270700834
Hospital Revenue Code	278
Min. Negotiated Rate	$397.14
Max. Negotiated Rate	$640.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$529.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.72
Rate for Payer: Qualcare PPO/HMO/WC	$397.14

Know your out-of-pocket cost for care.

All Charges