Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH FOX PTA SV 6x60x150cm

Facility

$925.00

Service Code	HCPCS C1725
Hospital Charge Code	270673124
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CATH FOX PTA SV 6x80x150cm

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270644404C
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 SV 6x80x150cm

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270644404C
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 SV 83964-02

Facility

$1,425.00

Hospital Charge Code	270644129C
Hospital Revenue Code	278
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

CATH FOX PTA SV 83964-02

Facility

$1,425.00

Hospital Charge Code	270644129C
Hospital Revenue Code	278
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

CATH FOX PTA SV 83976-02

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270644153C
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 SV 83976-02

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270644153C
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 SV 83980-02

Facility

$925.00

Service Code	HCPCS C1725
Hospital Charge Code	270644152C
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$277.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CATH FOX PTA SV 83980-02

Facility

$925.00

Service Code	HCPCS C1725
Hospital Charge Code	270644152C
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CATH FUSION PUSH 5X170 G31550

Facility

$342.00

Hospital Charge Code	270641701
Hospital Revenue Code	272
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$102.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.21
Rate for Payer: Cigna Commercial	$171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.46
Rate for Payer: Oxford Commercial	$171.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.30
Rate for Payer: UnitedHealthcare Commercial	$171.00

CATH FUSION PUSH 5X170 G31550

Facility

$342.00

Hospital Charge Code	270641701
Hospital Revenue Code	272
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$51.30
Rate for Payer: Qualcare PPO/HMO/WC	$51.30

CATH FX PTA 6x20x135 10336120

Facility

$775.00

Hospital Charge Code	270644309C
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 FX PTA 6x20x135 10336120

Facility

$775.00

Hospital Charge Code	270644309C
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 GASTROS 16FR 25CM G01425

Facility

$388.85

Hospital Charge Code	270640457
Hospital Revenue Code	272
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$194.43
Rate for Payer: Aetna Commercial	$116.66
Rate for Payer: Aetna Medicare Advantage	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.16
Rate for Payer: Cigna Commercial	$194.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.55
Rate for Payer: Oxford Commercial	$194.43
Rate for Payer: Qualcare PPO/HMO/WC	$58.33
Rate for Payer: UnitedHealthcare Commercial	$194.43

CATH GASTROS 16FR 25CM G01425

Facility

$388.85

Hospital Charge Code	270640457
Hospital Revenue Code	272
Min. Negotiated Rate	$58.33
Max. Negotiated Rate	$58.33
Rate for Payer: Qualcare PPO/HMO/WC	$58.33

CATH GLIDEPATH 31CM STR

Facility

$1,752.00

Hospital Charge Code	270677506
Hospital Revenue Code	278
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$423.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.98
Rate for Payer: Qualcare PPO/HMO/WC	$262.80

CATH GLIDEPATH 31CM STR

Facility

$1,752.00

Hospital Charge Code	270677506
Hospital Revenue Code	278
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$876.00
Rate for Payer: Aetna Commercial	$525.60
Rate for Payer: Aetna Medicare Advantage	$525.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.76
Rate for Payer: Cigna Commercial	$876.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.98
Rate for Payer: Qualcare PPO/HMO/WC	$262.80

CATH GLIDEPATH 42CM STR

Facility

$1,752.00

Hospital Charge Code	270677507
Hospital Revenue Code	278
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$876.00
Rate for Payer: Aetna Commercial	$525.60
Rate for Payer: Aetna Medicare Advantage	$525.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.76
Rate for Payer: Cigna Commercial	$876.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.98
Rate for Payer: Qualcare PPO/HMO/WC	$262.80

CATH GLIDEPATH 42CM STR

Facility

$1,752.00

Hospital Charge Code	270677507
Hospital Revenue Code	278
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$423.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.98
Rate for Payer: Qualcare PPO/HMO/WC	$262.80

CATH GUID 6F EBU 5.0 LA6EBU50

Facility

$225.00

Service Code	HCPCS C1887
Hospital Charge Code	270641795C
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CATH GUID 6F EBU 5.0 LA6EBU50

Facility

$225.00

Service Code	HCPCS C1887
Hospital Charge Code	270641795C
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CATH GUID 6F MACH 4.0 3435673

Facility

$255.00

Service Code	HCPCS C1887
Hospital Charge Code	270641796C
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

CATH GUID 6F MACH 4.0 3435673

Facility

$255.00

Service Code	HCPCS C1887
Hospital Charge Code	270641796C
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

CATH GUID 6F MACH 4.5 3435674

Facility

$310.00

Service Code	HCPCS C1887
Hospital Charge Code	270641797C
Hospital Revenue Code	278
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$75.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

CATH GUID 6F MACH 4.5 3435674

Facility

$310.00

Service Code	HCPCS C1887
Hospital Charge Code	270641797C
Hospital Revenue Code	278
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$93.00
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

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