Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH EXCELSIOR SL 10PS 90

Facility

$5,463.75

Service Code	HCPCS C1887
Hospital Charge Code	270695281S
Hospital Revenue Code	278
Min. Negotiated Rate	$819.56
Max. Negotiated Rate	$2,731.88
Rate for Payer: Aetna Commercial	$1,639.12
Rate for Payer: Aetna Medicare Advantage	$1,639.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,393.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,393.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,092.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,393.26
Rate for Payer: Cigna Commercial	$2,731.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,322.23
Rate for Payer: Qualcare PPO/HMO/WC	$819.56

CATH EXCELSIOR SL 2TIP 6X150CM

Facility

$5,027.25

Service Code	HCPCS C1887
Hospital Charge Code	270695280S
Hospital Revenue Code	272
Min. Negotiated Rate	$653.54
Max. Negotiated Rate	$2,513.62
Rate for Payer: Aetna Commercial	$1,508.17
Rate for Payer: Aetna Medicare Advantage	$1,508.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,281.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,281.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,281.95
Rate for Payer: Cigna Commercial	$2,513.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.54
Rate for Payer: Oxford Commercial	$2,513.62
Rate for Payer: Qualcare PPO/HMO/WC	$754.09
Rate for Payer: UnitedHealthcare Commercial	$2,513.62

CATH EXCELSIOR SL 2TIP 6X150CM

Facility

$5,027.25

Service Code	HCPCS C1887
Hospital Charge Code	270695280S
Hospital Revenue Code	272
Min. Negotiated Rate	$754.09
Max. Negotiated Rate	$754.09
Rate for Payer: Qualcare PPO/HMO/WC	$754.09

CATH EXCELSIOR SL2TIP PSC6X150

Facility

$5,027.25

Service Code	HCPCS C1887
Hospital Charge Code	270695285S
Hospital Revenue Code	272
Min. Negotiated Rate	$754.09
Max. Negotiated Rate	$754.09
Rate for Payer: Qualcare PPO/HMO/WC	$754.09

CATH EXCELSIOR SL2TIP PSC6X150

Facility

$5,027.25

Service Code	HCPCS C1887
Hospital Charge Code	270695285S
Hospital Revenue Code	272
Min. Negotiated Rate	$653.54
Max. Negotiated Rate	$2,513.62
Rate for Payer: Aetna Commercial	$1,508.17
Rate for Payer: Aetna Medicare Advantage	$1,508.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,281.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,281.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,281.95
Rate for Payer: Cigna Commercial	$2,513.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.54
Rate for Payer: Oxford Commercial	$2,513.62
Rate for Payer: Qualcare PPO/HMO/WC	$754.09
Rate for Payer: UnitedHealthcare Commercial	$2,513.62

CATH EXCELSIOR XT17PS457.5X150

Facility

$4,982.00

Service Code	HCPCS C1887
Hospital Charge Code	270695288S
Hospital Revenue Code	272
Min. Negotiated Rate	$647.66
Max. Negotiated Rate	$2,491.00
Rate for Payer: Aetna Commercial	$1,494.60
Rate for Payer: Aetna Medicare Advantage	$1,494.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,270.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,270.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,270.41
Rate for Payer: Cigna Commercial	$2,491.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$647.66
Rate for Payer: Oxford Commercial	$2,491.00
Rate for Payer: Qualcare PPO/HMO/WC	$747.30
Rate for Payer: UnitedHealthcare Commercial	$2,491.00

CATH EXCELSIOR XT17PS457.5X150

Facility

$4,982.00

Service Code	HCPCS C1887
Hospital Charge Code	270695288S
Hospital Revenue Code	272
Min. Negotiated Rate	$747.30
Max. Negotiated Rate	$747.30
Rate for Payer: Qualcare PPO/HMO/WC	$747.30

CATH EXPO 6F FR3 110 08641-01A

Facility

$107.95

Hospital Charge Code	270629431
Hospital Revenue Code	272
Min. Negotiated Rate	$14.03
Max. Negotiated Rate	$53.98
Rate for Payer: Aetna Commercial	$32.38
Rate for Payer: Aetna Medicare Advantage	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.53
Rate for Payer: Cigna Commercial	$53.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.03
Rate for Payer: Oxford Commercial	$53.98
Rate for Payer: Qualcare PPO/HMO/WC	$16.19
Rate for Payer: UnitedHealthcare Commercial	$53.98

CATH EXPO 6F FR3 110 08641-01A

Facility

$107.95

Hospital Charge Code	270629431
Hospital Revenue Code	272
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$16.19
Rate for Payer: Qualcare PPO/HMO/WC	$16.19

CATH EXPO 6FR FL3 100 0864120B

Facility

$107.95

Hospital Charge Code	270633300
Hospital Revenue Code	272
Min. Negotiated Rate	$14.03
Max. Negotiated Rate	$53.98
Rate for Payer: Aetna Commercial	$32.38
Rate for Payer: Aetna Medicare Advantage	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.53
Rate for Payer: Cigna Commercial	$53.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.03
Rate for Payer: Oxford Commercial	$53.98
Rate for Payer: Qualcare PPO/HMO/WC	$16.19
Rate for Payer: UnitedHealthcare Commercial	$53.98

CATH EXPO 6FR FL3 100 0864120B

Facility

$107.95

Hospital Charge Code	270633300
Hospital Revenue Code	272
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$16.19
Rate for Payer: Qualcare PPO/HMO/WC	$16.19

CATH EXTERNAL****

Facility

$30.00

Hospital Charge Code	8001042
Hospital Revenue Code	279
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

CATH EXTERNAL****

Facility

$30.00

Hospital Charge Code	8001042
Hospital Revenue Code	279
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

CATH EXTERNAL ADULT SELF-ADHES

Facility

$5.42

Hospital Charge Code	270649431
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

CATH EXTERNAL ADULT SELF-ADHES

Facility

$5.42

Hospital Charge Code	270649431
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$2.71

CATH EZM ANGIO 4F 90CM

Facility

$133.65

Hospital Charge Code	270601455
Hospital Revenue Code	272
Min. Negotiated Rate	$17.37
Max. Negotiated Rate	$66.83
Rate for Payer: Aetna Commercial	$40.09
Rate for Payer: Aetna Medicare Advantage	$40.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$66.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.37
Rate for Payer: Oxford Commercial	$66.83
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$66.83

CATH EZM ANGIO 4F 90CM

Facility

$133.65

Hospital Charge Code	270601455
Hospital Revenue Code	272
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

CATH FC PTA 6x80x135cm 1033680

Facility

$775.00

Hospital Charge Code	270644384C
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATH FC PTA 6x80x135cm 1033680

Facility

$775.00

Hospital Charge Code	270644384C
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATH FC PTA 9x40x80 10330-40

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644440C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATH FC PTA 9x40x80 10330-40

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644440C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
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) NJ Health	$125.00
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	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATH FEMALE EXTERNAL 10x1.in

Facility

$32.50

Hospital Charge Code	270679260
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$9.75
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.22
Rate for Payer: Oxford Commercial	$16.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$16.25

CATH FEMALE EXTERNAL 10x1.in

Facility

$32.50

Hospital Charge Code	270679260
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

CATH FETCH 2 ASPIRATION

Facility

$2,125.00

Service Code	HCPCS C1887
Hospital Charge Code	270657883
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

CATH FETCH 2 ASPIRATION

Facility

$2,125.00

Service Code	HCPCS C1887
Hospital Charge Code	270657883
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

Know your out-of-pocket cost for care.

All Charges