Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145
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 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145S
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 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145S
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 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145
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 SOS OMNI 1 5FR 0.035

Facility

$95.00

Hospital Charge Code	270CH0100
Hospital Revenue Code	272
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CATHETER SOS OMNI 1 5FR 0.035

Facility

$95.00

Hospital Charge Code	270CH0100
Hospital Revenue Code	272
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

Catheter sos omni (3)5fr80 cm

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623892
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

Catheter sos omni (3)5fr80 cm

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623892
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATHETER SOS OMNI (3) 5FR 80CM

Facility

$144.00

Hospital Charge Code	2703100925
Hospital Revenue Code	272
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

CATHETER SOS OMNI (3) 5FR 80CM

Facility

$144.00

Hospital Charge Code	2703100925
Hospital Revenue Code	272
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$43.20
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$72.00

CATHETER SOS OMNI II 5FR 0.035

Facility

$132.00

Hospital Charge Code	270CH0101
Hospital Revenue Code	272
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

CATHETER SOS OMNI II 5FR 0.035

Facility

$132.00

Hospital Charge Code	270CH0101
Hospital Revenue Code	272
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.16
Rate for Payer: Oxford Commercial	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Commercial	$66.00

CATHETER SPRINTER 3.25x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684712
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

CATHETER SPRINTER 3.25x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684712
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER SPRINTER 3.25x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684711
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER SPRINTER 3.25x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684711
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

CATHETER SPRINTER 3.75x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684713
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER SPRINTER 3.75x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684713
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

CATHETER SPYSCOPES DS II

Facility

$13,250.00

Hospital Charge Code	270686107
Hospital Revenue Code	272
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$1,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

CATHETER SPYSCOPES DS II

Facility

$13,250.00

Hospital Charge Code	270686107
Hospital Revenue Code	272
Min. Negotiated Rate	$1,722.50
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$3,975.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,722.50
Rate for Payer: Oxford Commercial	$6,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Commercial	$6,625.00

CATHETER STAY FIX 5F -14F

Facility

$45.00

Service Code	HCPCS C1729
Hospital Charge Code	270658019
Hospital Revenue Code	278
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

CATHETER STAY FIX 5F -14F

Facility

$45.00

Service Code	HCPCS C1729
Hospital Charge Code	270658019S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

CATHETER STAY FIX 5F -14F

Facility

$10.50

Service Code	HCPCS C1729
Hospital Charge Code	270658019N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$3.15
Rate for Payer: Aetna Medicare Advantage	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

CATHETER STAY FIX 5F -14F

Facility

$45.00

Hospital Charge Code	270658019R
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

Know your out-of-pocket cost for care.

All Charges