Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLMT URETERL STNT EXISTING RT

Facility

$13,218.42

Service Code	HCPCS 50693RT
Hospital Charge Code	2011584
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 RT

Facility

$13,218.42

Service Code	HCPCS 50693RT
Hospital Charge Code	2011584
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 URETRL STNT NEW W CTH

Facility

$13,218.42

Service Code	HCPCS 50695
Hospital Charge Code	7411619
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 URETRL STNT NEW W CTH

Facility

$13,218.42

Service Code	HCPCS 50695
Hospital Charge Code	7411619
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 URETRL STNT NEW W CTH

Facility

$17,139.40

Service Code	HCPCS 50695
Hospital Charge Code	2600230
Hospital Revenue Code	361
Min. Negotiated Rate	$2,570.91
Max. Negotiated Rate	$2,570.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.91

PLMT URETRL STNT NEW W CTH

Facility

$17,139.40

Service Code	HCPCS 50695
Hospital Charge Code	2600230
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,394.37
Rate for Payer: Aetna Commercial	$5,141.82
Rate for Payer: Aetna Medicare Advantage	$5,141.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,370.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,370.55
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	$4,370.55
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,228.12
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.91
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT URETRL STNT NEW W CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069550
Hospital Charge Code	2011578
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 URETRL STNT NEW W CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069550
Hospital Charge Code	2011578
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 URETRL STNT NEW W CTH LT

Facility

$13,218.42

Service Code	HCPCS 50695LT
Hospital Charge Code	2011593
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 URETRL STNT NEW W CTH LT

Facility

$13,218.42

Service Code	HCPCS 50695LT
Hospital Charge Code	2011593
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 URETRL STNT NEW W CTH RT

Facility

$13,218.42

Service Code	HCPCS 50695RT
Hospital Charge Code	2011586
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 URETRL STNT NEW W CTH RT

Facility

$13,218.42

Service Code	HCPCS 50695RT
Hospital Charge Code	2011586
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 URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	7411618
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 URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	2600229
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 URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	2600229
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 URETRL STNT NEW WO CTH

Facility

$13,218.42

Service Code	HCPCS 50694
Hospital Charge Code	7411618
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 URETRL STNT NEW WO CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069450
Hospital Charge Code	2011577
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 URETRL STNT NEW WO CTH BI

Facility

$13,218.42

Service Code	HCPCS 5069450
Hospital Charge Code	2011577
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 URETRL STNT NEW WO CTH LT

Facility

$13,218.42

Service Code	HCPCS 50694LT
Hospital Charge Code	2011592
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 URETRL STNT NEW WO CTH LT

Facility

$13,218.42

Service Code	HCPCS 50694LT
Hospital Charge Code	2011592
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 URETRL STNT NEW WO CTH RT

Facility

$13,218.42

Service Code	HCPCS 50694RT
Hospital Charge Code	2011585
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 URETRL STNT NEW WO CTH RT

Facility

$13,218.42

Service Code	HCPCS 50694RT
Hospital Charge Code	2011585
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 XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	2004959
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	321034709
Hospital Revenue Code	361
Min. Negotiated Rate	$309.33
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$309.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	321034709
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

Know your out-of-pocket cost for care.

All Charges