Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER SILICONE 8.5 FR X 26

Facility

$630.70

Service Code	HCPCS C2617
Hospital Charge Code	270698594
Hospital Revenue Code	278
Min. Negotiated Rate	$94.61
Max. Negotiated Rate	$315.35
Rate for Payer: Aetna Commercial	$189.21
Rate for Payer: Aetna Medicare Advantage	$189.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.83
Rate for Payer: Cigna Commercial	$315.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.63
Rate for Payer: Qualcare PPO/HMO/WC	$94.61

CATHETER SILICONE 8.5 FR X 26

Facility

$630.70

Service Code	HCPCS C2617
Hospital Charge Code	270698594
Hospital Revenue Code	278
Min. Negotiated Rate	$94.61
Max. Negotiated Rate	$152.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.63
Rate for Payer: Qualcare PPO/HMO/WC	$94.61

CATHETER SILVERHAWK L-SM LG VE

Facility

$15,625.00

Hospital Charge Code	270642865
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$3,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

CATHETER SILVERHAWK L-SM LG VE

Facility

$15,625.00

Hospital Charge Code	270642865
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$7,812.50
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: Aetna Commercial	$4,687.50
Rate for Payer: Aetna Medicare Advantage	$4,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,984.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

CATHETER SILVERHAWK L-SM LG VE

Facility

$15,625.00

Service Code	HCPCS C1714
Hospital Charge Code	270657512
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$7,812.50
Rate for Payer: Aetna Commercial	$4,687.50
Rate for Payer: Aetna Medicare Advantage	$4,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,984.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,984.38
Rate for Payer: Cigna Commercial	$7,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

CATHETER SILVERHAWK L-SM LG VE

Facility

$15,625.00

Service Code	HCPCS C1714
Hospital Charge Code	270657512
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.75
Max. Negotiated Rate	$3,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,781.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.75

CATHETER SIM2 RIST 120CM

Facility

$600.00

Service Code	HCPCS C1887
Hospital Charge Code	270696077S
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

CATHETER SIM2 RIST 120CM

Facility

$600.00

Service Code	HCPCS C1887
Hospital Charge Code	270696077S
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

CATHETER SIM I 5FR

Facility

$27.91

Hospital Charge Code	270651799
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

CATHETER SIM I 5FR

Facility

$27.91

Hospital Charge Code	270651799
Hospital Revenue Code	272
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$13.96
Rate for Payer: Aetna Commercial	$8.37
Rate for Payer: Aetna Medicare Advantage	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Oxford Commercial	$13.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$13.96

CATHETER SOLIAIRE PLAT 4X40 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685020S
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$9,068.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLIAIRE PLAT 4X40 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685020S
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$18,737.50
Rate for Payer: Aetna Commercial	$11,242.50
Rate for Payer: Aetna Medicare Advantage	$11,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,556.12
Rate for Payer: Cigna Commercial	$18,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLIAIRE PLAT 4X40 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685020
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$9,068.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLIAIRE PLAT 4X40 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685020
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$18,737.50
Rate for Payer: Aetna Commercial	$11,242.50
Rate for Payer: Aetna Medicare Advantage	$11,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,556.12
Rate for Payer: Cigna Commercial	$18,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLIDCROWNORBITAL2.25

Facility

$15,975.00

Hospital Charge Code	270642391
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$7,987.50
Rate for Payer: Aetna Commercial	$4,792.50
Rate for Payer: Aetna Medicare Advantage	$4,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,073.62
Rate for Payer: Cigna Commercial	$7,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLIDCROWNORBITAL2.25

Facility

$15,975.00

Hospital Charge Code	270642391
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$3,865.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLID CROWNORBITAL2MM

Facility

$15,975.00

Hospital Charge Code	270642015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$7,987.50
Rate for Payer: Aetna Commercial	$4,792.50
Rate for Payer: Aetna Medicare Advantage	$4,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,073.62
Rate for Payer: Cigna Commercial	$7,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLID CROWNORBITAL2MM

Facility

$15,975.00

Hospital Charge Code	270642015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$3,865.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLID CROWN ORBITAL A

Facility

$15,975.00

Hospital Charge Code	270642501
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$3,865.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLID CROWN ORBITAL A

Facility

$15,975.00

Hospital Charge Code	270642501
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$7,987.50
Rate for Payer: Aetna Commercial	$4,792.50
Rate for Payer: Aetna Medicare Advantage	$4,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,073.62
Rate for Payer: Cigna Commercial	$7,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLITAIRE 2 6x30 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685021
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$18,737.50
Rate for Payer: Aetna Commercial	$11,242.50
Rate for Payer: Aetna Medicare Advantage	$11,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,556.12
Rate for Payer: Cigna Commercial	$18,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLITAIRE 2 6x30 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685021
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$9,068.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$9,867.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$20,387.50
Rate for Payer: Aetna Commercial	$12,232.50
Rate for Payer: Aetna Medicare Advantage	$12,232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,397.62
Rate for Payer: Cigna Commercial	$20,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$9,867.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

Know your out-of-pocket cost for care.

All Charges