Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	3668503875
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-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	411050387B
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-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	2690620
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-REPL EXT URET STENT-BI

Facility

$4,540.00

Service Code	HCPCS 5038750
Hospital Charge Code	7411821
Hospital Revenue Code	361
Min. Negotiated Rate	$681.00
Max. Negotiated Rate	$681.00
Rate for Payer: Qualcare PPO/HMO/WC	$681.00

IR-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	321050387B
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-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	3668503875
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-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	2690620
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-REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	411050387B
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-REPL EXT URET STENT-BI

Facility

$4,540.00

Service Code	HCPCS 5038750
Hospital Charge Code	7411821
Hospital Revenue Code	361
Min. Negotiated Rate	$590.20
Max. Negotiated Rate	$2,270.00
Rate for Payer: Aetna Commercial	$1,362.00
Rate for Payer: Aetna Medicare Advantage	$1,362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,157.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,157.70
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	$1,157.70
Rate for Payer: Cigna Commercial	$2,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.20
Rate for Payer: Qualcare PPO/HMO/WC	$681.00

IR-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	366850387L
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-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	2691570
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-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	321050387L
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-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	366850387L
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-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	411050387L
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-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	2691570
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-REPL EXT URET STENT-LT

Facility

$4,540.00

Service Code	HCPCS 50387LT
Hospital Charge Code	7411962
Hospital Revenue Code	361
Min. Negotiated Rate	$681.00
Max. Negotiated Rate	$681.00
Rate for Payer: Qualcare PPO/HMO/WC	$681.00

IR-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	321050387L
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-REPL EXT URET STENT-LT

Facility

$4,540.00

Service Code	HCPCS 50387LT
Hospital Charge Code	7411962
Hospital Revenue Code	361
Min. Negotiated Rate	$590.20
Max. Negotiated Rate	$2,270.00
Rate for Payer: Aetna Commercial	$1,362.00
Rate for Payer: Aetna Medicare Advantage	$1,362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,157.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,157.70
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	$1,157.70
Rate for Payer: Cigna Commercial	$2,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.20
Rate for Payer: Qualcare PPO/HMO/WC	$681.00

IR-REPL EXT URET STENT-LT

Facility

$10,187.80

Service Code	HCPCS 50387LT
Hospital Charge Code	411050387L
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-REPL EXT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50387RT
Hospital Charge Code	366850387R
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-REPL EXT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50387RT
Hospital Charge Code	2691575
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-REPL EXT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50387RT
Hospital Charge Code	321050387R
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-REPL EXT URET STENT-RT

Facility

$4,540.00

Service Code	HCPCS 50387RT
Hospital Charge Code	7411963
Hospital Revenue Code	361
Min. Negotiated Rate	$681.00
Max. Negotiated Rate	$681.00
Rate for Payer: Qualcare PPO/HMO/WC	$681.00

IR-REPL EXT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50387RT
Hospital Charge Code	411050387R
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-REPL EXT URET STENT-RT

Facility

$10,187.80

Service Code	HCPCS 50387RT
Hospital Charge Code	366850387R
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

Know your out-of-pocket cost for care.

All Charges