Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR RNAL CYST STDY TRNSLMBR RGH

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2600111
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$199.46
Rate for Payer: Aetna Medicare Advantage	$199.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.54
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.73
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR RNAL CYST STDY TRNSLMBR RGH

Facility

$664.85

Service Code	HCPCS 74470
Hospital Charge Code	2600111
Hospital Revenue Code	320
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$99.73
Rate for Payer: Qualcare PPO/HMO/WC	$99.73

IRR NOZZLE F/05.001.063 F/PEN

Facility

$833.00

Hospital Charge Code	270674693
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/05.001.063 F/PEN

Facility

$833.00

Hospital Charge Code	270674693
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE F/05.001.177

Facility

$784.00

Hospital Charge Code	270674706
Hospital Revenue Code	272
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$392.00
Rate for Payer: Aetna Commercial	$235.20
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.92
Rate for Payer: Oxford Commercial	$392.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$392.00

IRR NOZZLE F/05.001.177

Facility

$784.00

Hospital Charge Code	270674706
Hospital Revenue Code	272
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$117.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

IRR NOZZLE F/ EPD RECIP ATTACH

Facility

$833.00

Hospital Charge Code	270674697
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/ EPD RECIP ATTACH

Facility

$833.00

Hospital Charge Code	270674697
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE F/ EPD SAG ATTACH

Facility

$833.00

Hospital Charge Code	270674164
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/ EPD SAG ATTACH

Facility

$833.00

Hospital Charge Code	270674164
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE F/HEX DRILL ATTACH

Facility

$833.00

Hospital Charge Code	270674699
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/HEX DRILL ATTACH

Facility

$833.00

Hospital Charge Code	270674699
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE-LONG F/E- PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674696
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE-LONG F/E- PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674696
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-MED F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674695
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-MED F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674695
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE-SHORT F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674694
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-SHORT F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674694
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IRR NOZZLE XXL F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674703
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE XXL F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674703
Hospital Revenue Code	272
Min. Negotiated Rate	$108.29
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.29
Rate for Payer: Oxford Commercial	$416.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$416.50

IR RTRVL FRGN BDY INTRVSC PERC

Facility

$2,238.00

Hospital Charge Code	2600112
Hospital Revenue Code	320
Min. Negotiated Rate	$290.94
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$671.40
Rate for Payer: Aetna Medicare Advantage	$671.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.69
Rate for Payer: Cigna Commercial	$1,119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.94
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR RTRVL FRGN BDY INTRVSC PERC

Facility

$2,238.00

Hospital Charge Code	2600112
Hospital Revenue Code	320
Min. Negotiated Rate	$335.70
Max. Negotiated Rate	$335.70
Rate for Payer: Qualcare PPO/HMO/WC	$335.70

IR-SEL CATH PLACET 1ST-BI

Facility

$242.00

Service Code	HCPCS 3601150
Hospital Charge Code	7411790
Hospital Revenue Code	761
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$72.60
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Oxford Commercial	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$121.00

IR-SEL CATH PLACET 1ST-BI

Facility

$242.00

Service Code	HCPCS 3601150
Hospital Charge Code	2690430
Hospital Revenue Code	761
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$72.60
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Oxford Commercial	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$121.00

IR-SEL CATH PLACET 1ST-BI

Facility

$242.00

Service Code	HCPCS 3601150
Hospital Charge Code	2690430
Hospital Revenue Code	761
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

Know your out-of-pocket cost for care.

All Charges