Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR ENDOVAS EXTEND PROSTH INIT

Facility

$4,000.00

Service Code	HCPCS 34825
Hospital Charge Code	7411400
Hospital Revenue Code	361
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENDOVAS EXTEND PROSTH INIT

Facility

$4,000.00

Service Code	HCPCS 34825
Hospital Charge Code	7411400
Hospital Revenue Code	361
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
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	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2600079
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411673
Hospital Revenue Code	320
Min. Negotiated Rate	$81.58
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$188.25
Rate for Payer: Aetna Medicare Advantage	$188.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.01
Rate for Payer: Cigna Commercial	$313.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.58
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411673
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2600079
Hospital Revenue Code	320
Min. Negotiated Rate	$81.58
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Medicare Advantage	$188.25
Rate for Payer: Aetna Commercial	$188.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.01
Rate for Payer: Cigna Commercial	$313.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.58
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR EPIDIDYMOGRAPHY

Facility

$906.25

Service Code	HCPCS 74440
Hospital Charge Code	2600080
Hospital Revenue Code	320
Min. Negotiated Rate	$45.25
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	$45.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.09
Rate for Payer: Cigna Commercial	$568.20
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 EPIDIDYMOGRAPHY

Facility

$906.25

Service Code	HCPCS 74440
Hospital Charge Code	2600080
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	7411661
Hospital Revenue Code	320
Min. Negotiated Rate	$51.35
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$118.50
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.35
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	2680250
Hospital Revenue Code	320
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	2680250
Hospital Revenue Code	320
Min. Negotiated Rate	$51.35
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$118.50
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.35
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	7411661
Hospital Revenue Code	320
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

IR ESOPHAGEAL FOREGN BODY RMVL

Facility

$804.30

Service Code	HCPCS 74235
Hospital Charge Code	2600085
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$120.64
Rate for Payer: Qualcare PPO/HMO/WC	$120.64

IR ESOPHAGEAL FOREGN BODY RMVL

Facility

$804.30

Service Code	HCPCS 74235
Hospital Charge Code	2600085
Hospital Revenue Code	320
Min. Negotiated Rate	$104.56
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$241.29
Rate for Payer: Aetna Medicare Advantage	$241.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.10
Rate for Payer: Cigna Commercial	$402.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.64
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IRESSA 250MG TAB

Facility

$75.00

Hospital Charge Code	60635886
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

IRESSA 250MG TAB

Facility

$75.00

Hospital Charge Code	60635886
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	7411794
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	7411794
Hospital Revenue Code	361
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$71.70
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
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	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.07
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	2690445
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	2690445
Hospital Revenue Code	361
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$71.70
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
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	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.07
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	7411906
Hospital Revenue Code	761
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	2691190
Hospital Revenue Code	761
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$71.70
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.07
Rate for Payer: Oxford Commercial	$119.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$119.50

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	2691190
Hospital Revenue Code	761
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	7411906
Hospital Revenue Code	761
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$71.70
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.07
Rate for Payer: Oxford Commercial	$119.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$119.50

IR-EST ACCE CAR/VET AR-RT

Facility

$239.00

Service Code	HCPCS 36100RT
Hospital Charge Code	7411907
Hospital Revenue Code	761
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

Know your out-of-pocket cost for care.

All Charges