Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	321025246L
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	2690950
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	7411870
Hospital Revenue Code	361
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$191.40
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.94
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	7411870
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	2690955
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	2690955
Hospital Revenue Code	361
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$191.40
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.94
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	2690330
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	7411774
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	7411774
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	2690330
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	7411867
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	2690940
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	7411867
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	2690940
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	321024220R
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	7411868
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	321024220R
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	7411868
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	2690945
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	2690945
Hospital Revenue Code	361
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	2670145
Hospital Revenue Code	361
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	7411592
Hospital Revenue Code	361
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$37.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	7411592
Hospital Revenue Code	361
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	2670145
Hospital Revenue Code	361
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$37.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-INJ FOR SIALOGRAPH-BIL

Facility

$793.00

Service Code	HCPCS 4255050
Hospital Charge Code	7411816
Hospital Revenue Code	761
Min. Negotiated Rate	$103.09
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$237.90
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.09
Rate for Payer: Oxford Commercial	$396.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$396.50

Know your out-of-pocket cost for care.

All Charges