Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR CYSTOSTOMY TUBE CHANGE SIMP

Facility

$1,355.15

Service Code	HCPCS 51705
Hospital Charge Code	2670140
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR CYSTOSTOMY TUBE CHANGE SIMP

Facility

$1,355.15

Service Code	HCPCS 51705
Hospital Charge Code	2670140
Hospital Revenue Code	361
Min. Negotiated Rate	$176.17
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$406.55
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.17
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-CYSTOURETHROSCOPY

Facility

$1,822.00

Service Code	HCPCS 52000
Hospital Charge Code	2690190
Hospital Revenue Code	361
Min. Negotiated Rate	$273.30
Max. Negotiated Rate	$273.30
Rate for Payer: Qualcare PPO/HMO/WC	$273.30

IR-CYSTOURETHROSCOPY

Facility

$1,822.00

Service Code	HCPCS 52000
Hospital Charge Code	7411628
Hospital Revenue Code	361
Min. Negotiated Rate	$273.30
Max. Negotiated Rate	$273.30
Rate for Payer: Qualcare PPO/HMO/WC	$273.30

IR-CYSTOURETHROSCOPY

Facility

$1,822.00

Service Code	HCPCS 52000
Hospital Charge Code	7411628
Hospital Revenue Code	361
Min. Negotiated Rate	$236.86
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$546.60
Rate for Payer: Aetna Medicare Advantage	$546.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.61
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	$464.61
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.86
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.30
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

IR-CYSTOURETHROSCOPY

Facility

$1,822.00

Service Code	HCPCS 52000
Hospital Charge Code	2690190
Hospital Revenue Code	361
Min. Negotiated Rate	$236.86
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$546.60
Rate for Payer: Aetna Medicare Advantage	$546.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.61
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	$464.61
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.86
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.30
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

IR CYSTURETHROSCOPY

Facility

$11,620.55

Service Code	HCPCS 52351
Hospital Charge Code	2004523
Hospital Revenue Code	361
Min. Negotiated Rate	$1,510.67
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$3,486.16
Rate for Payer: Aetna Medicare Advantage	$3,486.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,963.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,963.24
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	$2,963.24
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,510.67
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.08
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

IR CYSTURETHROSCOPY

Facility

$11,620.55

Service Code	HCPCS 52351
Hospital Charge Code	2004523
Hospital Revenue Code	361
Min. Negotiated Rate	$1,743.08
Max. Negotiated Rate	$1,743.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.08

IR & D DEEP FOREARM OR WRIST

Facility

$9,394.00

Service Code	HCPCS 25028
Hospital Charge Code	2680070
Hospital Revenue Code	361
Min. Negotiated Rate	$1,221.22
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$2,818.20
Rate for Payer: Aetna Medicare Advantage	$2,818.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.47
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	$2,395.47
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,221.22
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.10
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

IR & D DEEP FOREARM OR WRIST

Facility

$9,394.00

Service Code	HCPCS 25028
Hospital Charge Code	7411363
Hospital Revenue Code	361
Min. Negotiated Rate	$1,221.22
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$2,818.20
Rate for Payer: Aetna Medicare Advantage	$2,818.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.47
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	$2,395.47
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,221.22
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.10
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

IR & D DEEP FOREARM OR WRIST

Facility

$9,394.00

Service Code	HCPCS 25028
Hospital Charge Code	7411363
Hospital Revenue Code	361
Min. Negotiated Rate	$1,409.10
Max. Negotiated Rate	$1,409.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.10

IR & D DEEP FOREARM OR WRIST

Facility

$9,394.00

Service Code	HCPCS 25028
Hospital Charge Code	2680070
Hospital Revenue Code	361
Min. Negotiated Rate	$1,409.10
Max. Negotiated Rate	$1,409.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.10

IR DIGITAL SUBTR ANGIO

Facility

$1,628.85

Hospital Charge Code	2001642
Hospital Revenue Code	320
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$488.65
Rate for Payer: Aetna Medicare Advantage	$488.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.36
Rate for Payer: Cigna Commercial	$814.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.33
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR DIGITAL SUBTR ANGIO

Facility

$1,628.85

Hospital Charge Code	2001642
Hospital Revenue Code	320
Min. Negotiated Rate	$244.33
Max. Negotiated Rate	$244.33
Rate for Payer: Qualcare PPO/HMO/WC	$244.33

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	321047542
Hospital Revenue Code	361
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Qualcare PPO/HMO/WC	$109.80

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	2692121
Hospital Revenue Code	361
Min. Negotiated Rate	$95.16
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$219.60
Rate for Payer: Aetna Medicare Advantage	$219.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.66
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	$186.66
Rate for Payer: Cigna Commercial	$125.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	7411570
Hospital Revenue Code	361
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Qualcare PPO/HMO/WC	$109.80

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	321047542
Hospital Revenue Code	361
Min. Negotiated Rate	$95.16
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$219.60
Rate for Payer: Aetna Medicare Advantage	$219.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.66
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	$186.66
Rate for Payer: Cigna Commercial	$125.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	7411570
Hospital Revenue Code	361
Min. Negotiated Rate	$95.16
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$219.60
Rate for Payer: Aetna Medicare Advantage	$219.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.66
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	$186.66
Rate for Payer: Cigna Commercial	$125.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR DILATE BILIARY DUCT/AMPULLA

Facility

$732.00

Service Code	HCPCS 47542
Hospital Charge Code	2692121
Hospital Revenue Code	361
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Qualcare PPO/HMO/WC	$109.80

IR DIL BILIARY DUCT W/ STENT

Facility

$26,912.85

Service Code	HCPCS 47556
Hospital Charge Code	2000940
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	366847556
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$7,279.26
Rate for Payer: Aetna Medicare Advantage	$7,279.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,187.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,187.37
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	$6,187.37
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,154.35
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR DIL BILIARY DUCT W/ STENT

Facility

$26,912.85

Service Code	HCPCS 47556
Hospital Charge Code	321047556
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	411047556
Hospital Revenue Code	361
Min. Negotiated Rate	$3,639.63
Max. Negotiated Rate	$3,639.63
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63

IR DIL BILIARY DUCT W/ STENT

Facility

$24,264.20

Service Code	HCPCS 47556
Hospital Charge Code	411047556
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$7,279.26
Rate for Payer: Aetna Medicare Advantage	$7,279.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,187.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,187.37
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	$6,187.37
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,154.35
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,639.63
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges