Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	7411625
Hospital Revenue Code	361
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	7411625
Hospital Revenue Code	361
Min. Negotiated Rate	$62.27
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$143.70
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
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	$122.14
Rate for Payer: Cigna Commercial	$63.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.27
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	2670230
Hospital Revenue Code	361
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	2670230
Hospital Revenue Code	361
Min. Negotiated Rate	$62.27
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$143.70
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
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	$122.14
Rate for Payer: Cigna Commercial	$63.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.27
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	5600220
Hospital Revenue Code	361
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	7411440
Hospital Revenue Code	361
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	5600220
Hospital Revenue Code	361
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
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	$95.62
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	7411440
Hospital Revenue Code	361
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
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	$95.62
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	2690325
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	2690325
Hospital Revenue Code	361
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	7411773
Hospital Revenue Code	361
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	7411773
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	2680055
Hospital Revenue Code	361
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$529.80
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
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	$450.33
Rate for Payer: Cigna Commercial	$45.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.58
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	7411360
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	7411360
Hospital Revenue Code	361
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$529.80
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
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	$450.33
Rate for Payer: Cigna Commercial	$45.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.58
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	2680055
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

IR-INJ SHOULDER ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	7411865
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	2690930
Hospital Revenue Code	361
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	7411865
Hospital Revenue Code	361
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	2690930
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	7411866
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	2690935
Hospital Revenue Code	361
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	2690935
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	7411866
Hospital Revenue Code	361
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	2680040
Hospital Revenue Code	361
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
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	$38.25
Rate for Payer: Cigna Commercial	$42.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges