Heights University Hospital

All Charges

Charge

Type

Setting

Price

CYSTOURETERO&OR PYELOSCOP-LT

Facility

$23,841.70

Service Code	HCPCS 52351
Hospital Charge Code	160000221
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

CYSTOURETERO&OR PYELOSCOP-LT

Facility

$23,841.70

Service Code	HCPCS 52351
Hospital Charge Code	160000221
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$7,152.51
Rate for Payer: Aetna Medicare Advantage	$7,152.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,079.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,079.63
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	$6,079.63
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,099.42
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTO/URETERO STRICTURE TX

Facility

$12,648.60

Service Code	HCPCS 52344
Hospital Charge Code	16001000
Hospital Revenue Code	360
Min. Negotiated Rate	$1,644.32
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$3,794.58
Rate for Payer: Aetna Medicare Advantage	$3,794.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,225.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,225.39
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	$3,225.39
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,644.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,897.29
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTO/URETERO STRICTURE TX

Facility

$12,648.60

Service Code	HCPCS 52344
Hospital Charge Code	16001000
Hospital Revenue Code	360
Min. Negotiated Rate	$1,897.29
Max. Negotiated Rate	$1,897.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,897.29

CYSTOURETERO W/BIOPSY

Facility

$23,947.12

Service Code	HCPCS 52354
Hospital Charge Code	160000187
Hospital Revenue Code	360
Min. Negotiated Rate	$3,592.07
Max. Negotiated Rate	$3,592.07
Rate for Payer: Qualcare PPO/HMO/WC	$3,592.07

CYSTOURETERO W/BIOPSY

Facility

$23,947.12

Service Code	HCPCS 52354
Hospital Charge Code	160000187
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$12,768.54
Rate for Payer: Aetna Commercial	$7,184.14
Rate for Payer: Aetna Medicare Advantage	$7,184.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,106.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,106.52
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	$6,106.52
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,113.13
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,592.07
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTO/URETERO W/LITHOTRIPSY

Facility

$36,677.50

Service Code	HCPCS 52356
Hospital Charge Code	16000169
Hospital Revenue Code	360
Min. Negotiated Rate	$5,501.62
Max. Negotiated Rate	$5,501.62
Rate for Payer: Qualcare PPO/HMO/WC	$5,501.62

CYSTO/URETERO W/LITHOTRIPSY

Facility

$36,677.50

Service Code	HCPCS 52356
Hospital Charge Code	16000169
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$12,768.54
Rate for Payer: Aetna Commercial	$11,003.25
Rate for Payer: Aetna Medicare Advantage	$11,003.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,352.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,352.76
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	$9,352.76
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,768.07
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,501.62
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

CYSTOURETHROSCOPY

Facility

$9,122.85

Service Code	HCPCS 52000
Hospital Charge Code	16000288
Hospital Revenue Code	360
Min. Negotiated Rate	$1,185.97
Max. Negotiated Rate	$2,736.86
Rate for Payer: Aetna Commercial	$2,736.86
Rate for Payer: Aetna Medicare Advantage	$2,736.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.33
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	$2,326.33
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.43
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CYSTOURETHROSCOPY

Facility

$9,122.85

Service Code	HCPCS 52000
Hospital Charge Code	16000288
Hospital Revenue Code	360
Min. Negotiated Rate	$1,368.43
Max. Negotiated Rate	$1,368.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.43

CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT URETHRAL STENT

Facility

$8,394.37

Service Code	CPT 52282
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTOURETHROSCOPY W URETERA LT

Facility

$24,549.79

Service Code	HCPCS 52005
Hospital Charge Code	16000648
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,364.94
Rate for Payer: Aetna Commercial	$7,364.94
Rate for Payer: Aetna Medicare Advantage	$7,364.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,260.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,260.20
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	$6,260.20
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,191.47
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTOURETHROSCOPY W URETERA LT

Facility

$24,549.79

Service Code	HCPCS 52005
Hospital Charge Code	16000648
Hospital Revenue Code	360
Min. Negotiated Rate	$3,682.47
Max. Negotiated Rate	$3,682.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47

CYSTOURETHRO W/ ADDL IMPLANT

Facility

$1,886.00

Service Code	HCPCS 52442
Hospital Charge Code	160000226
Hospital Revenue Code	360
Min. Negotiated Rate	$47.57
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$565.80
Rate for Payer: Aetna Medicare Advantage	$565.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$480.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$480.93
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	$480.93
Rate for Payer: Cigna Commercial	$47.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.18
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CYSTOURETHRO W/ ADDL IMPLANT

Facility

$1,886.00

Service Code	HCPCS 52442
Hospital Charge Code	160000226
Hospital Revenue Code	360
Min. Negotiated Rate	$282.90
Max. Negotiated Rate	$282.90
Rate for Payer: Qualcare PPO/HMO/WC	$282.90

CYSTOURETHRO W/IMPLANT

Facility

$4,290.00

Service Code	HCPCS 52441
Hospital Charge Code	160000225
Hospital Revenue Code	360
Min. Negotiated Rate	$643.50
Max. Negotiated Rate	$643.50
Rate for Payer: Qualcare PPO/HMO/WC	$643.50

CYSTOURETHRO W/IMPLANT

Facility

$4,290.00

Service Code	HCPCS 52441
Hospital Charge Code	160000225
Hospital Revenue Code	360
Min. Negotiated Rate	$199.37
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,287.00
Rate for Payer: Aetna Medicare Advantage	$1,287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.95
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	$1,093.95
Rate for Payer: Cigna Commercial	$199.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$643.50
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CYSTOURE W INC EJACUL DUCTS

Facility

$23,841.70

Service Code	HCPCS 52402
Hospital Charge Code	1600000765
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$7,152.51
Rate for Payer: Aetna Medicare Advantage	$7,152.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,079.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,079.63
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	$6,079.63
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,099.42
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTOURE W INC EJACUL DUCTS

Facility

$23,841.70

Service Code	HCPCS 52402
Hospital Charge Code	1600000765
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

CYSTO UROLOGY KIT

Facility

$31.00

Hospital Charge Code	270338740
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$15.50

CYSTO UROLOGY KIT

Facility

$31.00

Hospital Charge Code	270338740
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

CYSTO W DIR VISION INT URETHRO

Facility

$17,676.60

Service Code	HCPCS 52276
Hospital Charge Code	160000189
Hospital Revenue Code	360
Min. Negotiated Rate	$2,651.49
Max. Negotiated Rate	$2,651.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,651.49

CYSTO W DIR VISION INT URETHRO

Facility

$17,676.60

Service Code	HCPCS 52276
Hospital Charge Code	160000189
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$5,302.98
Rate for Payer: Aetna Medicare Advantage	$5,302.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,507.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,507.53
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	$4,507.53
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,297.96
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,651.49
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CYSTO W FLG BLDR TUMOR 0.5-2.0

Facility

$14,872.30

Service Code	HCPCS 52234
Hospital Charge Code	160000176
Hospital Revenue Code	360
Min. Negotiated Rate	$2,230.84
Max. Negotiated Rate	$2,230.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,230.84

CYSTO W FLG BLDR TUMOR 0.5-2.0

Facility

$14,872.30

Service Code	HCPCS 52234
Hospital Charge Code	160000176
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$4,461.69
Rate for Payer: Aetna Medicare Advantage	$4,461.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,792.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,792.44
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	$3,792.44
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,933.40
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,230.84
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

Know your out-of-pocket cost for care.

All Charges