Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER ECHELON 10 MICRO 45 D

Facility

$4,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685191S
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CATHETER ECHELON 10 MICRO 45D

Facility

$4,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685191C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CATHETER ECHELON 10 MICRO 45D

Facility

$4,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685191C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CATHETER EMBOLECTOMY OW 3FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685900
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 3FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685900
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 4FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685911
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 4FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685911
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 5FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685912
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 5FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685912
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 6FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685913
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 6FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685913
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 7FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685914
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER EMBOLECTOMY OW 7FR

Facility

$900.00

Service Code	HCPCS C1757
Hospital Charge Code	270685914
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATHETER ENDOTRACHEAL 35FR

Facility

$586.00

Hospital Charge Code	270331066
Hospital Revenue Code	272
Min. Negotiated Rate	$87.90
Max. Negotiated Rate	$87.90
Rate for Payer: Qualcare PPO/HMO/WC	$87.90

CATHETER ENDOTRACHEAL 35FR

Facility

$586.00

Hospital Charge Code	270331066
Hospital Revenue Code	272
Min. Negotiated Rate	$76.18
Max. Negotiated Rate	$293.00
Rate for Payer: Aetna Commercial	$175.80
Rate for Payer: Aetna Medicare Advantage	$175.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.43
Rate for Payer: Cigna Commercial	$293.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.18
Rate for Payer: Oxford Commercial	$293.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.90
Rate for Payer: UnitedHealthcare Commercial	$293.00

CATHETER ENDOTRACHEAL 37 FR

Facility

$501.00

Hospital Charge Code	270330818
Hospital Revenue Code	272
Min. Negotiated Rate	$75.15
Max. Negotiated Rate	$75.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.15

CATHETER ENDOTRACHEAL 37 FR

Facility

$501.00

Hospital Charge Code	270330818
Hospital Revenue Code	272
Min. Negotiated Rate	$65.13
Max. Negotiated Rate	$250.50
Rate for Payer: Aetna Commercial	$150.30
Rate for Payer: Aetna Medicare Advantage	$150.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.75
Rate for Payer: Cigna Commercial	$250.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.13
Rate for Payer: Oxford Commercial	$250.50
Rate for Payer: Qualcare PPO/HMO/WC	$75.15
Rate for Payer: UnitedHealthcare Commercial	$250.50

CATHETER ENDOTRACHEAL 39FR

Facility

$501.00

Hospital Charge Code	270331109
Hospital Revenue Code	272
Min. Negotiated Rate	$75.15
Max. Negotiated Rate	$75.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.15

CATHETER ENDOTRACHEAL 39FR

Facility

$501.00

Hospital Charge Code	270331109
Hospital Revenue Code	272
Min. Negotiated Rate	$65.13
Max. Negotiated Rate	$250.50
Rate for Payer: Aetna Commercial	$150.30
Rate for Payer: Aetna Medicare Advantage	$150.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.75
Rate for Payer: Cigna Commercial	$250.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.13
Rate for Payer: Oxford Commercial	$250.50
Rate for Payer: Qualcare PPO/HMO/WC	$75.15
Rate for Payer: UnitedHealthcare Commercial	$250.50

CATHETER ENVOY 5F 90CM

Facility

$0.01

Service Code	HCPCS C1887
Hospital Charge Code	270697878S
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CATHETER ENVOY 5F 90CM

Facility

$0.01

Service Code	HCPCS C1887
Hospital Charge Code	270697878S
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CATHETER EQUISTREAM 14.5 X 23C

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270660249
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER EQUISTREAM 14.5 X 23C

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270660249
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$577.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER EVD ANTIBIOTIC

Facility

$1,390.50

Service Code	HCPCS C1729
Hospital Charge Code	270670472
Hospital Revenue Code	278
Min. Negotiated Rate	$208.57
Max. Negotiated Rate	$695.25
Rate for Payer: Aetna Commercial	$417.15
Rate for Payer: Aetna Medicare Advantage	$417.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.58
Rate for Payer: Cigna Commercial	$695.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.50
Rate for Payer: Qualcare PPO/HMO/WC	$208.57

CATHETER EVD ANTIBIOTIC

Facility

$1,390.50

Service Code	HCPCS C1729
Hospital Charge Code	270670472
Hospital Revenue Code	278
Min. Negotiated Rate	$208.57
Max. Negotiated Rate	$336.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.50
Rate for Payer: Qualcare PPO/HMO/WC	$208.57

Know your out-of-pocket cost for care.

All Charges