Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLMT NEPHROURETERAL CATH

Facility

$8,875.68

Service Code	HCPCS 50433
Hospital Charge Code	2250437
Hospital Revenue Code	361
Min. Negotiated Rate	$1,331.35
Max. Negotiated Rate	$1,331.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.35

PLMT NEPHROURETERAL CATH

Facility

$10,187.80

Service Code	HCPCS 50433
Hospital Charge Code	2600225
Hospital Revenue Code	361
Min. Negotiated Rate	$1,324.41
Max. Negotiated Rate	$8,394.37
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	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.41
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

PLMT NEPHROURETERAL CATH

Facility

$8,875.68

Service Code	HCPCS 50433
Hospital Charge Code	411050433
Hospital Revenue Code	361
Min. Negotiated Rate	$1,153.84
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$2,662.70
Rate for Payer: Aetna Medicare Advantage	$2,662.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,263.30
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	$2,263.30
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.84
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.35
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

PLMT NEPHROURETERAL CATH BIL

Facility

$8,875.68

Service Code	HCPCS 5043350
Hospital Charge Code	2011573
Hospital Revenue Code	361
Min. Negotiated Rate	$1,331.35
Max. Negotiated Rate	$1,331.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.35

PLMT NEPHROURETERAL CATH BIL

Facility

$8,875.68

Service Code	HCPCS 5043350
Hospital Charge Code	2011573
Hospital Revenue Code	361
Min. Negotiated Rate	$1,153.84
Max. Negotiated Rate	$4,437.84
Rate for Payer: Aetna Commercial	$2,662.70
Rate for Payer: Aetna Medicare Advantage	$2,662.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,263.30
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	$2,263.30
Rate for Payer: Cigna Commercial	$4,437.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.35

PLMT NEPHROURETERAL CATHETER

Facility

$6,782.72

Service Code	HCPCS 50433
Hospital Charge Code	1600000428
Hospital Revenue Code	360
Min. Negotiated Rate	$881.75
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Medicare Advantage	$2,034.82
Rate for Payer: Aetna Commercial	$2,034.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,729.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,729.59
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	$1,729.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$881.75
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

PLMT NEPHROURETERAL CATHETER

Facility

$6,782.72

Service Code	HCPCS 50433
Hospital Charge Code	1600000428
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.41
Max. Negotiated Rate	$1,017.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41

PLMT NEPHROURETERAL CATH LT

Facility

$8,875.68

Service Code	HCPCS 50433LT
Hospital Charge Code	2011588
Hospital Revenue Code	361
Min. Negotiated Rate	$1,331.35
Max. Negotiated Rate	$1,331.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.35

PLMT NEPHROURETERAL CATH LT

Facility

$8,875.68

Service Code	HCPCS 50433LT
Hospital Charge Code	2011588
Hospital Revenue Code	361
Min. Negotiated Rate	$1,153.84
Max. Negotiated Rate	$4,437.84
Rate for Payer: Aetna Commercial	$2,662.70
Rate for Payer: Aetna Medicare Advantage	$2,662.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,263.30
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	$2,263.30
Rate for Payer: Cigna Commercial	$4,437.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.35

PLMT NEPHROURETERAL CATH RT

Facility

$9,500.00

Service Code	HCPCS 50433RT
Hospital Charge Code	2250435
Hospital Revenue Code	361
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
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	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

PLMT NEPHROURETERAL CATH RT

Facility

$9,500.00

Service Code	HCPCS 50433RT
Hospital Charge Code	2250435
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	7411617
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	7411617
Hospital Revenue Code	361
Min. Negotiated Rate	$1,718.39
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$3,965.53
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.39
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	411050693
Hospital Revenue Code	361
Min. Negotiated Rate	$1,752.78
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$4,044.87
Rate for Payer: Aetna Medicare Advantage	$4,044.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,438.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,438.14
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	$3,438.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,752.78
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	366850693
Hospital Revenue Code	361
Min. Negotiated Rate	$1,752.78
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$4,044.87
Rate for Payer: Aetna Medicare Advantage	$4,044.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,438.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,438.14
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	$3,438.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,752.78
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	366850693
Hospital Revenue Code	361
Min. Negotiated Rate	$2,022.43
Max. Negotiated Rate	$2,022.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	321050693
Hospital Revenue Code	361
Min. Negotiated Rate	$1,718.39
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$3,965.53
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.39
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT URETERL STNT EXISTING

Facility

$13,482.90

Service Code	HCPCS 50693
Hospital Charge Code	411050693
Hospital Revenue Code	361
Min. Negotiated Rate	$2,022.43
Max. Negotiated Rate	$2,022.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.43

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	2600228
Hospital Revenue Code	361
Min. Negotiated Rate	$1,718.39
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$3,965.53
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.39
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	2600228
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING

Facility

$13,218.42

Service Code	HCPCS 50693
Hospital Charge Code	321050693
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING BI

Facility

$13,218.42

Service Code	HCPCS 5069350
Hospital Charge Code	2011576
Hospital Revenue Code	361
Min. Negotiated Rate	$1,718.39
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$3,965.53
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING BI

Facility

$13,218.42

Service Code	HCPCS 5069350
Hospital Charge Code	2011576
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING LT

Facility

$13,218.42

Service Code	HCPCS 50693LT
Hospital Charge Code	2011591
Hospital Revenue Code	361
Min. Negotiated Rate	$1,718.39
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$3,965.53
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETERL STNT EXISTING LT

Facility

$13,218.42

Service Code	HCPCS 50693LT
Hospital Charge Code	2011591
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

Know your out-of-pocket cost for care.

All Charges