Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	2680040
Hospital Revenue Code	361
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	7411349
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

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	7411349
Hospital Revenue Code	361
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

IR-INJ URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	2690680
Hospital Revenue Code	761
Min. Negotiated Rate	$122.46
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$282.60
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.46
Rate for Payer: Oxford Commercial	$471.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$471.00

IR-INJ URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	7411829
Hospital Revenue Code	761
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

IR-INJ URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	2690680
Hospital Revenue Code	761
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

IR-INJ URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	7411829
Hospital Revenue Code	761
Min. Negotiated Rate	$122.46
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$282.60
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.46
Rate for Payer: Oxford Commercial	$471.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$471.00

IRINOTECAN 20 MG/ML INJ

Facility

$4,625.35

Service Code	HCPCS J9206
Hospital Charge Code	6017073
Hospital Revenue Code	636
Min. Negotiated Rate	$693.80
Max. Negotiated Rate	$1,119.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.33
Rate for Payer: Qualcare PPO/HMO/WC	$693.80

IRINOTECAN 20 MG/ML INJ

Facility

$4,625.35

Service Code	HCPCS J9206
Hospital Charge Code	6017073
Hospital Revenue Code	636
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1,387.61
Rate for Payer: Aetna Commercial	$1,387.61
Rate for Payer: Aetna Medicare Advantage	$1,387.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,179.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,179.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,179.46
Rate for Payer: Cigna Commercial	$1.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.33
Rate for Payer: Qualcare PPO/HMO/WC	$693.80

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	321036251
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	5700253
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	321036251
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Better Health Medicaid	$7,075.29
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	5700253
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Better Health Medicaid	$7,075.29
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	5700264
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	321036252
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	321036252
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Better Health Medicaid	$7,075.29
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	5700264
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Better Health Medicaid	$7,075.29
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH REN ART 2ND UNILAT

Facility

$25,628.45

Service Code	HCPCS 36253
Hospital Charge Code	321036253
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$7,688.53
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
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	$6,535.25
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,331.70
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR INS CATH REN ART 2ND UNILAT

Facility

$25,628.45

Service Code	HCPCS 36253
Hospital Charge Code	5700211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

IR INS CATH REN ART 2ND UNILAT

Facility

$25,628.45

Service Code	HCPCS 36253
Hospital Charge Code	5700211
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$7,688.53
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
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	$6,535.25
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,331.70
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR INS CATH REN ART 2ND UNILAT

Facility

$21,323.35

Service Code	HCPCS 36253
Hospital Charge Code	366836253
Hospital Revenue Code	361
Min. Negotiated Rate	$3,198.50
Max. Negotiated Rate	$3,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50

IR INS CATH REN ART 2ND UNILAT

Facility

$12,311.10

Service Code	HCPCS 36253
Hospital Charge Code	7411434
Hospital Revenue Code	361
Min. Negotiated Rate	$1,600.44
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$3,693.33
Rate for Payer: Aetna Medicare Advantage	$3,693.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,139.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,139.33
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	$3,139.33
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,600.44
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,846.66
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR INS CATH REN ART 2ND UNILAT

Facility

$21,323.35

Service Code	HCPCS 36253
Hospital Charge Code	366836253
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,397.01
Rate for Payer: Aetna Medicare Advantage	$6,397.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,437.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,437.45
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	$5,437.45
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.04
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

IR INS CATH REN ART 2ND UNILAT

Facility

$25,628.45

Service Code	HCPCS 36253
Hospital Charge Code	321036253
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

IR INS CATH REN ART 2ND UNILAT

Facility

$21,323.35

Service Code	HCPCS 36253
Hospital Charge Code	411036253
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,397.01
Rate for Payer: Aetna Medicare Advantage	$6,397.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,437.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,437.45
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	$5,437.45
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.04
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges