Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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

$13,811.90

Service Code	HCPCS 47556
Hospital Charge Code	7411573
Hospital Revenue Code	361
Min. Negotiated Rate	$2,071.78
Max. Negotiated Rate	$2,071.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78

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	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$8,073.85
Rate for Payer: Aetna Medicare Advantage	$8,073.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,862.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,862.78
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	$6,862.78
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,498.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
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	2000940
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$8,073.85
Rate for Payer: Aetna Medicare Advantage	$8,073.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,862.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,862.78
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	$6,862.78
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,498.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR DIL BILIARY DUCT W/ STENT

Facility

$13,811.90

Service Code	HCPCS 47556
Hospital Charge Code	7411573
Hospital Revenue Code	361
Min. Negotiated Rate	$1,795.55
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$4,143.57
Rate for Payer: Aetna Medicare Advantage	$4,143.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,522.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,522.03
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	$3,522.03
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,795.55
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	7411830
Hospital Revenue Code	361
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	2690685
Hospital Revenue Code	361
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	7411830
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-BIL

Facility

$327.00

Service Code	HCPCS 5389950
Hospital Charge Code	2690685
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	7411982
Hospital Revenue Code	361
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	2691710
Hospital Revenue Code	361
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	7411982
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-LT

Facility

$327.00

Service Code	HCPCS 53899LT
Hospital Charge Code	2691710
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	366853899R
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	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.17
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	366853899R
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	321053899R
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	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.17
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$327.00

Service Code	HCPCS 53899RT
Hospital Charge Code	7411983
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	2691715
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	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.17
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	321053899R
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	411053899
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	411053899
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	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.17
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$327.00

Service Code	HCPCS 53899RT
Hospital Charge Code	7411983
Hospital Revenue Code	361
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	2691715
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR DIR-ARTERGRM CAROT CERE UNI

Facility

$12,400.74

Service Code	HCPCS 75665
Hospital Charge Code	2680325
Hospital Revenue Code	323
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

IR DIR-ARTERGRM CAROT CERE UNI

Facility

$12,400.74

Service Code	HCPCS 75665
Hospital Charge Code	2680325
Hospital Revenue Code	323
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$6,200.37
Rate for Payer: Aetna Commercial	$3,720.22
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,162.19
Rate for Payer: Cigna Commercial	$6,200.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges