Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	2691255
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	7411909
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	7411909
Hospital Revenue Code	361
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.80
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.18
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2101176
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2101176
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 PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411674
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 PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411674
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR PLCMT URETERAL STENT NEW

Facility

$20,157.00

Service Code	HCPCS 50694
Hospital Charge Code	5701113
Hospital Revenue Code	361
Min. Negotiated Rate	$3,023.55
Max. Negotiated Rate	$3,023.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,023.55

IR PLCMT URETERAL STENT NEW

Facility

$20,157.00

Service Code	HCPCS 50694
Hospital Charge Code	5701113
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$6,047.10
Rate for Payer: Aetna Medicare Advantage	$6,047.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,140.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,140.03
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	$5,140.03
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,620.41
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,023.55
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	2680120
Hospital Revenue Code	361
Min. Negotiated Rate	$522.78
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,206.40
Rate for Payer: Aetna Medicare Advantage	$1,206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,025.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,025.44
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	$1,025.44
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.78
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$603.20
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	7411376
Hospital Revenue Code	361
Min. Negotiated Rate	$603.20
Max. Negotiated Rate	$603.20
Rate for Payer: Qualcare PPO/HMO/WC	$603.20

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	2680120
Hospital Revenue Code	361
Min. Negotiated Rate	$603.20
Max. Negotiated Rate	$603.20
Rate for Payer: Qualcare PPO/HMO/WC	$603.20

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	7411376
Hospital Revenue Code	361
Min. Negotiated Rate	$522.78
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,206.40
Rate for Payer: Aetna Medicare Advantage	$1,206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,025.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,025.44
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	$1,025.44
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.78
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$603.20
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	2680115
Hospital Revenue Code	361
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	7411582
Hospital Revenue Code	361
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	7411582
Hospital Revenue Code	361
Min. Negotiated Rate	$297.66
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$686.90
Rate for Payer: Aetna Medicare Advantage	$686.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$583.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$583.87
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	$583.87
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.66
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.45
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	2680115
Hospital Revenue Code	361
Min. Negotiated Rate	$297.66
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$686.90
Rate for Payer: Aetna Medicare Advantage	$686.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$583.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$583.87
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	$583.87
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.66
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.45
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR-PREOP PLA NDL-BREST-BI

Facility

$240.00

Hospital Charge Code	2009140
Hospital Revenue Code	761
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IR-PREOP PLA NDL-BREST-BI

Facility

$240.00

Hospital Charge Code	2009140
Hospital Revenue Code	761
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$120.00

IR-PREOP PLA NDL-BREST-LT

Facility

$240.00

Hospital Charge Code	2009185
Hospital Revenue Code	761
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$120.00

IR-PREOP PLA NDL-BREST-LT

Facility

$240.00

Hospital Charge Code	2009185
Hospital Revenue Code	761
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IR-PREOP PLA NDL-BREST-RT

Facility

$240.00

Hospital Charge Code	2009190
Hospital Revenue Code	761
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$120.00

IR-PREOP PLA NDL-BREST-RT

Facility

$240.00

Hospital Charge Code	2009190
Hospital Revenue Code	761
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IR-PRE-OP PLCMNT NDDLE LOC WIR

Facility

$996.00

Hospital Charge Code	2680015
Hospital Revenue Code	361
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

IR-PRE-OP PLCMNT NDDLE LOC WIR

Facility

$996.00

Hospital Charge Code	2680015
Hospital Revenue Code	361
Min. Negotiated Rate	$129.48
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: Aetna Medicare Advantage	$298.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.98
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	$253.98
Rate for Payer: Cigna Commercial	$498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.48
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

Know your out-of-pocket cost for care.

All Charges