Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER INFUSION 2.25I 20 GA

Facility

$210.00

Service Code	HCPCS C1751
Hospital Charge Code	270682903
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$50.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

CATHETER,INFUSION,O/THAN HEMO

Facility

$21.40

Service Code	HCPCS C1751
Hospital Charge Code	4800910
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

CATHETER,INFUSION,O/THAN HEMO

Facility

$21.40

Service Code	HCPCS C1751
Hospital Charge Code	4800910
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$6.42
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

CATHETER IV SAFETY 22GAX1 3350

Facility

$11.65

Hospital Charge Code	270621005
Hospital Revenue Code	272
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare Advantage	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.97
Rate for Payer: Cigna Commercial	$5.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.75
Rate for Payer: UnitedHealthcare Commercial	$5.83

CATHETER IV SAFETY 22GAX1 3350

Facility

$11.65

Hospital Charge Code	270621005
Hospital Revenue Code	272
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.75

CATHETER IV SURFLO TEFLON

Facility

$9.70

Hospital Charge Code	270658290
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

CATHETER IV SURFLO TEFLON

Facility

$9.70

Hospital Charge Code	270658290
Hospital Revenue Code	272
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$4.85
Rate for Payer: Aetna Commercial	$2.91
Rate for Payer: Aetna Medicare Advantage	$2.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.47
Rate for Payer: Cigna Commercial	$4.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.26
Rate for Payer: Oxford Commercial	$4.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$4.85

CATHETERIZE URETHRA, SIMPLE

Facility

$435.25

Service Code	HCPCS 51701
Hospital Charge Code	2500365
Hospital Revenue Code	761
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$65.29
Rate for Payer: Qualcare PPO/HMO/WC	$65.29

CATHETERIZE URETHRA, SIMPLE

Facility

$435.25

Service Code	HCPCS 51701
Hospital Charge Code	2500365
Hospital Revenue Code	761
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$130.57
Rate for Payer: Aetna Medicare Advantage	$130.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.99
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.58
Rate for Payer: Oxford Commercial	$217.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.29
Rate for Payer: UnitedHealthcare Commercial	$217.62

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060S
Hospital Revenue Code	272
Min. Negotiated Rate	$1,816.75
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$4,192.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,816.75
Rate for Payer: Oxford Commercial	$6,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Commercial	$6,987.50

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060
Hospital Revenue Code	272
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$2,096.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060S
Hospital Revenue Code	272
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$2,096.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060
Hospital Revenue Code	272
Min. Negotiated Rate	$1,816.75
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$4,192.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,816.75
Rate for Payer: Oxford Commercial	$6,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Commercial	$6,987.50

CATHETER JETSTREAM G3 SE 1.6

Facility

$16,500.00

Hospital Charge Code	2709007405
Hospital Revenue Code	272
Min. Negotiated Rate	$2,145.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,145.00
Rate for Payer: Oxford Commercial	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$8,250.00

CATHETER JETSTREAM G3 SE 1.6

Facility

$16,500.00

Hospital Charge Code	2709007405
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM G3 SF 1.6

Facility

$16,500.00

Hospital Charge Code	270CH0005
Hospital Revenue Code	272
Min. Negotiated Rate	$2,145.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,145.00
Rate for Payer: Oxford Commercial	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$8,250.00

CATHETER JETSTREAM G3 SF 1.6

Facility

$16,500.00

Hospital Charge Code	270CH0005
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$4,837.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	2709007406
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$4,837.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	270CH0006
Hospital Revenue Code	272
Min. Negotiated Rate	$2,145.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,145.00
Rate for Payer: Oxford Commercial	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$8,250.00

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	270CH0006
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

Know your out-of-pocket cost for care.

All Charges