Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER OPTITORQUE 5FR TIGER

Facility

$275.00

Hospital Charge Code	2709007303
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418S
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATHETER OTW SPLIT 5913230

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418N
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 OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$526.50
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418S
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$526.50
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATHETER OTW SPLIT 5913230

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418N
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 OTW, XK, 19cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0057
Hospital Revenue Code	272
Min. Negotiated Rate	$250.25
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) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.25
Rate for Payer: Oxford Commercial	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$962.50

CATHETER OTW, XK, 19cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0057
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW, XK, 23cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0058
Hospital Revenue Code	272
Min. Negotiated Rate	$250.25
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) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.25
Rate for Payer: Oxford Commercial	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$962.50

CATHETER OTW, XK, 23cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0058
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404S
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$547.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404N
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 OTW XK 27CM SPLIT

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404N
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 OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404S
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$547.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATHETER OTW, XK, 27cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0059
Hospital Revenue Code	272
Min. Negotiated Rate	$250.25
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) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.25
Rate for Payer: Oxford Commercial	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$962.50

CATHETER OTW, XK, 27cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0059
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW, XK, 31cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0060
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW, XK, 31cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0060
Hospital Revenue Code	272
Min. Negotiated Rate	$250.25
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) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.25
Rate for Payer: Oxford Commercial	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$962.50

CATHETER OUTBACK RE-ENTRY

Facility

$11,490.00

Hospital Charge Code	2709003190
Hospital Revenue Code	272
Min. Negotiated Rate	$1,493.70
Max. Negotiated Rate	$5,745.00
Rate for Payer: Aetna Commercial	$3,447.00
Rate for Payer: Aetna Medicare Advantage	$3,447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,929.95
Rate for Payer: Cigna Commercial	$5,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,493.70
Rate for Payer: Oxford Commercial	$5,745.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,723.50
Rate for Payer: UnitedHealthcare Commercial	$5,745.00

CATHETER OUTBACK RE-ENTRY

Facility

$11,490.00

Hospital Charge Code	2709003190
Hospital Revenue Code	272
Min. Negotiated Rate	$1,723.50
Max. Negotiated Rate	$1,723.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,723.50

CATHETER PALINDRONE DIALY 19CM

Facility

$2,183.60

Hospital Charge Code	270669446
Hospital Revenue Code	278
Min. Negotiated Rate	$327.54
Max. Negotiated Rate	$528.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54

CATHETER PALINDRONE DIALY 19CM

Facility

$2,183.60

Hospital Charge Code	270669446
Hospital Revenue Code	278
Min. Negotiated Rate	$327.54
Max. Negotiated Rate	$1,091.80
Rate for Payer: Aetna Commercial	$655.08
Rate for Payer: Aetna Medicare Advantage	$655.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.82
Rate for Payer: Cigna Commercial	$1,091.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54

Know your out-of-pocket cost for care.

All Charges