Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	7411601
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	2670005
Hospital Revenue Code	361
Min. Negotiated Rate	$175.52
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$405.05
Rate for Payer: Aetna Medicare Advantage	$405.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.29
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	$344.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.52
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	366849465
Hospital Revenue Code	361
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
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	$714.00
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	7411601
Hospital Revenue Code	361
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
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	$714.00
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	411049465
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	2670005
Hospital Revenue Code	361
Min. Negotiated Rate	$202.52
Max. Negotiated Rate	$202.52
Rate for Payer: Qualcare PPO/HMO/WC	$202.52

IR CONTRAST INJ PEG TUBE

Facility

$1,350.15

Service Code	HCPCS 49465
Hospital Charge Code	321049465
Hospital Revenue Code	361
Min. Negotiated Rate	$175.52
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$405.05
Rate for Payer: Aetna Medicare Advantage	$405.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.29
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	$344.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.52
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	411049465
Hospital Revenue Code	361
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
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	$714.00
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-CONV G-TUBE / G-J-TUBE

Facility

$8,686.35

Service Code	HCPCS 49446
Hospital Charge Code	7411596
Hospital Revenue Code	361
Min. Negotiated Rate	$1,302.95
Max. Negotiated Rate	$1,302.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95

IR-CONV G-TUBE / G-J-TUBE

Facility

$8,686.35

Service Code	HCPCS 49446
Hospital Charge Code	7411596
Hospital Revenue Code	361
Min. Negotiated Rate	$1,129.23
Max. Negotiated Rate	$4,569.67
Rate for Payer: Aetna Commercial	$2,605.91
Rate for Payer: Aetna Medicare Advantage	$2,605.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,215.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,215.02
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	$2,215.02
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.23
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR-CONV G-TUBE / G-J-TUBE

Facility

$2,595.00

Service Code	HCPCS 49446
Hospital Charge Code	2690160
Hospital Revenue Code	361
Min. Negotiated Rate	$389.25
Max. Negotiated Rate	$389.25
Rate for Payer: Qualcare PPO/HMO/WC	$389.25

IR-CONV G-TUBE / G-J-TUBE

Facility

$2,595.00

Service Code	HCPCS 49446
Hospital Charge Code	2690160
Hospital Revenue Code	361
Min. Negotiated Rate	$337.35
Max. Negotiated Rate	$4,569.67
Rate for Payer: Aetna Commercial	$778.50
Rate for Payer: Aetna Medicare Advantage	$778.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$661.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$661.73
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	$661.73
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.35
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$389.25
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR CORPORA CAVERNOSOGRAPHY

Facility

$1,092.60

Service Code	HCPCS 74445
Hospital Charge Code	2680310
Hospital Revenue Code	320
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$327.78
Rate for Payer: Aetna Medicare Advantage	$327.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.61
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.89
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR CORPORA CAVERNOSOGRAPHY

Facility

$1,092.60

Service Code	HCPCS 74445
Hospital Charge Code	7411681
Hospital Revenue Code	320
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$327.78
Rate for Payer: Aetna Medicare Advantage	$327.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.61
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.89
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR CORPORA CAVERNOSOGRAPHY

Facility

$1,092.60

Service Code	HCPCS 74445
Hospital Charge Code	7411681
Hospital Revenue Code	320
Min. Negotiated Rate	$163.89
Max. Negotiated Rate	$163.89
Rate for Payer: Qualcare PPO/HMO/WC	$163.89

IR CORPORA CAVERNOSOGRAPHY

Facility

$1,092.60

Service Code	HCPCS 74445
Hospital Charge Code	2680310
Hospital Revenue Code	320
Min. Negotiated Rate	$163.89
Max. Negotiated Rate	$163.89
Rate for Payer: Qualcare PPO/HMO/WC	$163.89

IR CORPORA CAVERNOSOGRAPHY

Facility

$906.25

Service Code	HCPCS 74445
Hospital Charge Code	2600059
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

IR CORPORA CAVERNOSOGRAPHY

Facility

$906.25

Service Code	HCPCS 74445
Hospital Charge Code	2600059
Hospital Revenue Code	320
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.09
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR CREATE PASSAGE TO KIDNEY

Facility

$8,535.00

Service Code	HCPCS 50395
Hospital Charge Code	7411605
Hospital Revenue Code	361
Min. Negotiated Rate	$1,280.25
Max. Negotiated Rate	$1,280.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25

IR CREATE PASSAGE TO KIDNEY

Facility

$8,535.00

Service Code	HCPCS 50395
Hospital Charge Code	5600171
Hospital Revenue Code	361
Min. Negotiated Rate	$1,280.25
Max. Negotiated Rate	$1,280.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25

IR CREATE PASSAGE TO KIDNEY

Facility

$8,535.00

Service Code	HCPCS 50395
Hospital Charge Code	7411605
Hospital Revenue Code	361
Min. Negotiated Rate	$1,109.55
Max. Negotiated Rate	$4,267.50
Rate for Payer: Aetna Commercial	$2,560.50
Rate for Payer: Aetna Medicare Advantage	$2,560.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,176.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,176.43
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	$2,176.43
Rate for Payer: Cigna Commercial	$4,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25

IR CREATE PASSAGE TO KIDNEY

Facility

$8,535.00

Service Code	HCPCS 50395
Hospital Charge Code	5600171
Hospital Revenue Code	361
Min. Negotiated Rate	$1,109.55
Max. Negotiated Rate	$4,267.50
Rate for Payer: Aetna Commercial	$2,560.50
Rate for Payer: Aetna Medicare Advantage	$2,560.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,176.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,176.43
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	$2,176.43
Rate for Payer: Cigna Commercial	$4,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25

IR CTA LOWER EXTREMITY W/WO CO

Facility

$2,013.25

Service Code	HCPCS 73706
Hospital Charge Code	7411671
Hospital Revenue Code	350
Min. Negotiated Rate	$301.99
Max. Negotiated Rate	$301.99
Rate for Payer: Qualcare PPO/HMO/WC	$301.99

IR CTA LOWER EXTREMITY W/WO CO

Facility

$2,013.25

Service Code	HCPCS 73706
Hospital Charge Code	2680300
Hospital Revenue Code	350
Min. Negotiated Rate	$301.99
Max. Negotiated Rate	$301.99
Rate for Payer: Qualcare PPO/HMO/WC	$301.99

IR CTA LOWER EXTREMITY W/WO CO

Facility

$2,013.25

Service Code	HCPCS 73706
Hospital Charge Code	7411671
Hospital Revenue Code	350
Min. Negotiated Rate	$261.72
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Better Health Medicaid	$940.08
Rate for Payer: Aetna Commercial	$603.98
Rate for Payer: Aetna Medicare Advantage	$603.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$513.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$513.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$349.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$513.38
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.72
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$301.99
Rate for Payer: UnitedHealthcare Commercial	$2,773.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$958.88

Know your out-of-pocket cost for care.

All Charges