Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-REM INT URET STENT-LT

Facility

$5,475.00

Service Code	HCPCS 50384LT
Hospital Charge Code	7411960
Hospital Revenue Code	361
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$821.25
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IR-REM INT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50384LT
Hospital Charge Code	321050384L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50384LT
Hospital Charge Code	2691560
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	2691565
Hospital Revenue Code	361
Min. Negotiated Rate	$1,324.41
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,056.34
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$5,475.00

Service Code	HCPCS 50384RT
Hospital Charge Code	7411961
Hospital Revenue Code	361
Min. Negotiated Rate	$711.75
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$1,642.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
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	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.75
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	2691565
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	321050384R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50384RT
Hospital Charge Code	321050384R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,324.41
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,056.34
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

IR-REM INT URET STENT-RT

Facility

$5,475.00

Service Code	HCPCS 50384RT
Hospital Charge Code	7411961
Hospital Revenue Code	361
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$821.25
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	7411822
Hospital Revenue Code	361
Min. Negotiated Rate	$275.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$634.80
Rate for Payer: Aetna Medicare Advantage	$634.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.58
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	$539.58
Rate for Payer: Cigna Commercial	$1,058.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.08
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	2690625
Hospital Revenue Code	361
Min. Negotiated Rate	$275.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$634.80
Rate for Payer: Aetna Medicare Advantage	$634.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.58
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	$539.58
Rate for Payer: Cigna Commercial	$1,058.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.08
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	7411822
Hospital Revenue Code	361
Min. Negotiated Rate	$317.40
Max. Negotiated Rate	$317.40
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-BI

Facility

$2,116.00

Service Code	HCPCS 5038950
Hospital Charge Code	2690625
Hospital Revenue Code	361
Min. Negotiated Rate	$317.40
Max. Negotiated Rate	$317.40
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-LT

Facility

$2,116.00

Service Code	HCPCS 50389LT
Hospital Charge Code	7411964
Hospital Revenue Code	361
Min. Negotiated Rate	$275.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$634.80
Rate for Payer: Aetna Medicare Advantage	$634.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.58
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	$539.58
Rate for Payer: Cigna Commercial	$1,058.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.08
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	2691580
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	411050389L
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$2,116.00

Service Code	HCPCS 50389LT
Hospital Charge Code	7411964
Hospital Revenue Code	361
Min. Negotiated Rate	$317.40
Max. Negotiated Rate	$317.40
Rate for Payer: Qualcare PPO/HMO/WC	$317.40

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	321050389L
Hospital Revenue Code	361
Min. Negotiated Rate	$428.02
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$987.75
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,646.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.02
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	2691580
Hospital Revenue Code	361
Min. Negotiated Rate	$428.02
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$987.75
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,646.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.02
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	366850389L
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	366850389L
Hospital Revenue Code	361
Min. Negotiated Rate	$428.02
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$987.75
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,646.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.02
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	321050389L
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-LT

Facility

$3,292.50

Service Code	HCPCS 50389LT
Hospital Charge Code	411050389L
Hospital Revenue Code	361
Min. Negotiated Rate	$428.02
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$987.75
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,646.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.02
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	2691585
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

IR-REM NEPHROSTOM TUBE-RT

Facility

$3,292.50

Service Code	HCPCS 50389RT
Hospital Charge Code	411050389R
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

Know your out-of-pocket cost for care.

All Charges