Heights University Hospital

All Charges

Charge

Type

Setting

Price

CONVERSION EXT BIL DRG CATH

Facility

$17,259.20

Service Code	HCPCS 47535
Hospital Charge Code	321047535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	366847535
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,526.35
Rate for Payer: Aetna Commercial	$4,366.44
Rate for Payer: Aetna Medicare Advantage	$4,366.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,711.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,711.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,711.47
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,892.12
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	7411564
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

CONVERT NEPHROSTOMY CATH

Facility

$10,187.80

Service Code	HCPCS 50434
Hospital Charge Code	2600226
Hospital Revenue Code	361
Min. Negotiated Rate	$1,324.41
Max. Negotiated Rate	$4,978.04
Rate for Payer: Aetna Commercial	$3,056.34
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.41
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CONVERT NEPHROSTOMY CATH

Facility

$10,187.80

Service Code	HCPCS 50434
Hospital Charge Code	2600226
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

CONVERT NEPHROSTOMY CATH

Facility

$10,187.80

Service Code	HCPCS 50434
Hospital Charge Code	321050434
Hospital Revenue Code	361
Min. Negotiated Rate	$1,324.41
Max. Negotiated Rate	$4,978.04
Rate for Payer: Aetna Commercial	$3,056.34
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.41
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CONVERT NEPHROSTOMY CATH

Facility

$3,090.18

Service Code	HCPCS 50434
Hospital Charge Code	7411610
Hospital Revenue Code	361
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$4,978.04
Rate for Payer: Aetna Commercial	$927.05
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$788.00
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.72
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CONVERT NEPHROSTOMY CATH

Facility

$3,090.18

Service Code	HCPCS 50434
Hospital Charge Code	7411610
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERT NEPHROSTOMY CATH

Facility

$10,187.80

Service Code	HCPCS 50434
Hospital Charge Code	321050434
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

CONVERT NEPHROSTOMY CATH BIL

Facility

$3,090.18

Service Code	HCPCS 5043450
Hospital Charge Code	2011574
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERT NEPHROSTOMY CATH BIL

Facility

$3,090.18

Service Code	HCPCS 5043450
Hospital Charge Code	2011574
Hospital Revenue Code	361
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$927.05
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.72
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERT NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50434LT
Hospital Charge Code	2011589
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERT NEPHROSTOMY CATH LT

Facility

$3,090.18

Service Code	HCPCS 50434LT
Hospital Charge Code	2011589
Hospital Revenue Code	361
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$927.05
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.72
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERT NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50434RT
Hospital Charge Code	2011582
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERT NEPHROSTOMY CATH RT

Facility

$3,090.18

Service Code	HCPCS 50434RT
Hospital Charge Code	2011582
Hospital Revenue Code	361
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$927.05
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$788.00
Rate for Payer: Cigna Commercial	$1,545.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.72
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

CONVERTOR SEAL-UP II 5 175070

Facility

$100.85

Hospital Charge Code	270600063
Hospital Revenue Code	272
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

CONVERTOR SEAL-UP II 5 175070

Facility

$100.85

Hospital Charge Code	270600063
Hospital Revenue Code	272
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11
Rate for Payer: Oxford Commercial	$50.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$50.42

CONVERTOR SPECIMEN

Facility

$9.78

Hospital Charge Code	270651486
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$4.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$4.89

CONVERTOR SPECIMEN

Facility

$9.78

Hospital Charge Code	270651486
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

CONVERTOR SURGIPOR 10.5 ****

Facility

$27.00

Hospital Charge Code	1603299
Hospital Revenue Code	272
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$13.50

CONVERTOR SURGIPOR 10.5 ****

Facility

$27.00

Hospital Charge Code	1603299
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

CONVERTOR SURGIPOR 10.5 175011

Facility

$50.45

Hospital Charge Code	270600058
Hospital Revenue Code	272
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

CONVERTOR SURGIPOR 10.5 175011

Facility

$50.45

Hospital Charge Code	270600058
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$15.13
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.56
Rate for Payer: Oxford Commercial	$25.23
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$25.23

CONVERTOR SURGIPOR 4.5 *****

Facility

$24.00

Hospital Charge Code	1603273
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$12.00

CONVERTOR SURGIPOR 4.5 *****

Facility

$24.00

Hospital Charge Code	1603273
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

Know your out-of-pocket cost for care.

All Charges