Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR CHANGE PERC BIL DRAIN CATH

Facility

$2,682.45

Hospital Charge Code	2004739
Hospital Revenue Code	361
Min. Negotiated Rate	$348.72
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$804.74
Rate for Payer: Aetna Medicare Advantage	$804.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.02
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	$684.02
Rate for Payer: Cigna Commercial	$1,341.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.72
Rate for Payer: Qualcare PPO/HMO/WC	$402.37

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	2690675
Hospital Revenue Code	361
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$624.60
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.66
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	2690675
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	7411828
Hospital Revenue Code	361
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$624.60
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.66
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-BI

Facility

$2,082.00

Service Code	HCPCS 5068850
Hospital Charge Code	7411828
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	2691690
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	2691690
Hospital Revenue Code	361
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$624.60
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.66
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	7411978
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-LT

Facility

$2,082.00

Service Code	HCPCS 50688LT
Hospital Charge Code	7411978
Hospital Revenue Code	361
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$624.60
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.66
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	2691695
Hospital Revenue Code	361
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$624.60
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.66
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	2691695
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	7411979
Hospital Revenue Code	361
Min. Negotiated Rate	$270.66
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$624.60
Rate for Payer: Aetna Medicare Advantage	$624.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.91
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	$530.91
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.66
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHANGE URETER TUBE-RT

Facility

$2,082.00

Service Code	HCPCS 50688RT
Hospital Charge Code	7411979
Hospital Revenue Code	361
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	2690135
Hospital Revenue Code	361
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	7411557
Hospital Revenue Code	361
Min. Negotiated Rate	$920.09
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$6,300.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
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	$5,355.00
Rate for Payer: Cigna Commercial	$920.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,730.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	7411557
Hospital Revenue Code	361
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00

IR-CHOLECYS W/EXPL DRAIN

Facility

$21,000.00

Service Code	HCPCS 47480
Hospital Charge Code	2690135
Hospital Revenue Code	361
Min. Negotiated Rate	$920.09
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$6,300.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
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	$5,355.00
Rate for Payer: Cigna Commercial	$920.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,730.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	2600056
Hospital Revenue Code	320
Min. Negotiated Rate	$72.93
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$98.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	7411731
Hospital Revenue Code	320
Min. Negotiated Rate	$72.93
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$98.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	7411731
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	2600056
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

IR CNTRL VENOUS CATHTER STRPNG

Facility

$602.00

Service Code	HCPCS 75901
Hospital Charge Code	7411730
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

IR CNTRL VENOUS CATHTER STRPNG

Facility

$602.00

Service Code	HCPCS 75901
Hospital Charge Code	7411730
Hospital Revenue Code	320
Min. Negotiated Rate	$76.67
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	366849465
Hospital Revenue Code	361
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

IR CONTRAST INJ PEG TUBE

Facility

$1,350.15

Service Code	HCPCS 49465
Hospital Charge Code	321049465
Hospital Revenue Code	361
Min. Negotiated Rate	$202.52
Max. Negotiated Rate	$202.52
Rate for Payer: Qualcare PPO/HMO/WC	$202.52

Know your out-of-pocket cost for care.

All Charges