Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH FOX PTA 5mm x120mm x150cm

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270643698
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATH FOX PTA 5mm x120mm x150cm

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270643698
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATH FOX PTA 5X20MM

Facility

$1,075.00

Hospital Charge Code	270634856C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CATH FOX PTA 5X20MM

Facility

$1,075.00

Hospital Charge Code	270634856C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CATH FOX PTA 5x20mm UA12005

Facility

$1,075.00

Hospital Charge Code	270634856V
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CATH FOX PTA 5x20mm UA12005

Facility

$843.25

Hospital Charge Code	270634856
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x20mm UA12005

Facility

$843.25

Hospital Charge Code	270634856
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x20mm UA12005

Facility

$1,075.00

Hospital Charge Code	270634856V
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 6x120x150 8398402

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270643975C
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

CATH FOX PTA 6x120x150 8398402

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270643975C
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$352.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

CATH FOX PTA 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634855V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634855V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$252.97
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 7x20mm UA12007

Facility

$843.25

Hospital Charge Code	270634855
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

Know your out-of-pocket cost for care.

All Charges