Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	7411632
Hospital Revenue Code	361
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare Advantage	$138.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.59
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	$117.59
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.95
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	2680220
Hospital Revenue Code	361
Min. Negotiated Rate	$69.17
Max. Negotiated Rate	$69.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.17

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	2680220
Hospital Revenue Code	361
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare Advantage	$138.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.59
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	$117.59
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.95
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	7411827
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	7411827
Hospital Revenue Code	761
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.22
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$447.00

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	2690670
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	2690670
Hospital Revenue Code	761
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.22
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$447.00

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	7411976
Hospital Revenue Code	761
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.22
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$447.00

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	2691680
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	2691680
Hospital Revenue Code	761
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.22
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$447.00

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	7411976
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	2691685
Hospital Revenue Code	761
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.22
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$447.00

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	7411977
Hospital Revenue Code	761
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.22
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$447.00

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	2691685
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	7411977
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	321051600
Hospital Revenue Code	361
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$230.70
Rate for Payer: Aetna Medicare Advantage	$230.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.09
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	$196.09
Rate for Payer: Cigna Commercial	$40.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.97
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$115.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	321051600
Hospital Revenue Code	361
Min. Negotiated Rate	$115.35
Max. Negotiated Rate	$115.35
Rate for Payer: Qualcare PPO/HMO/WC	$115.35

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	2670225
Hospital Revenue Code	361
Min. Negotiated Rate	$115.35
Max. Negotiated Rate	$115.35
Rate for Payer: Qualcare PPO/HMO/WC	$115.35

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	2670225
Hospital Revenue Code	361
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$230.70
Rate for Payer: Aetna Medicare Advantage	$230.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.09
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	$196.09
Rate for Payer: Cigna Commercial	$40.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.97
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$115.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	7411623
Hospital Revenue Code	361
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$230.70
Rate for Payer: Aetna Medicare Advantage	$230.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.09
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	$196.09
Rate for Payer: Cigna Commercial	$40.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.97
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$115.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	7411623
Hospital Revenue Code	361
Min. Negotiated Rate	$115.35
Max. Negotiated Rate	$115.35
Rate for Payer: Qualcare PPO/HMO/WC	$115.35

IR URTRAL CTH/STNT PLC PERC LF

Facility

$1,962.45

Hospital Charge Code	2600121
Hospital Revenue Code	320
Min. Negotiated Rate	$294.37
Max. Negotiated Rate	$294.37
Rate for Payer: Qualcare PPO/HMO/WC	$294.37

IR URTRAL CTH/STNT PLC PERC LF

Facility

$1,962.45

Hospital Charge Code	2600121
Hospital Revenue Code	320
Min. Negotiated Rate	$255.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$588.74
Rate for Payer: Aetna Medicare Advantage	$588.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$500.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$500.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$500.42
Rate for Payer: Cigna Commercial	$981.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$294.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR URTRAL CTH/STNT PLC PERC RG

Facility

$1,962.45

Hospital Charge Code	2600122
Hospital Revenue Code	320
Min. Negotiated Rate	$294.37
Max. Negotiated Rate	$294.37
Rate for Payer: Qualcare PPO/HMO/WC	$294.37

IR URTRAL CTH/STNT PLC PERC RG

Facility

$1,962.45

Hospital Charge Code	2600122
Hospital Revenue Code	320
Min. Negotiated Rate	$255.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$588.74
Rate for Payer: Aetna Medicare Advantage	$588.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$500.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$500.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$500.42
Rate for Payer: Cigna Commercial	$981.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$294.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges