Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR PLACE CECOSTOMY TUBE PERC

Facility

$5,547.05

Service Code	HCPCS 49442
Hospital Charge Code	5600161
Hospital Revenue Code	361
Min. Negotiated Rate	$832.06
Max. Negotiated Rate	$832.06
Rate for Payer: Qualcare PPO/HMO/WC	$832.06

XR PLACE DUOD/JEJ TUBE PERC

Facility

$3,929.65

Service Code	HCPCS 49441
Hospital Charge Code	5600160
Hospital Revenue Code	361
Min. Negotiated Rate	$510.85
Max. Negotiated Rate	$4,569.67
Rate for Payer: Aetna Commercial	$1,178.89
Rate for Payer: Aetna Medicare Advantage	$1,178.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,002.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,002.06
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	$1,002.06
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.85
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$589.45
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR PLACE DUOD/JEJ TUBE PERC

Facility

$3,929.65

Service Code	HCPCS 49441
Hospital Charge Code	5600160
Hospital Revenue Code	361
Min. Negotiated Rate	$589.45
Max. Negotiated Rate	$589.45
Rate for Payer: Qualcare PPO/HMO/WC	$589.45

XR PTA BALLOON FEMOR POPLITEAL

Facility

$8,843.05

Hospital Charge Code	5600006
Hospital Revenue Code	361
Min. Negotiated Rate	$1,326.46
Max. Negotiated Rate	$1,326.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.46

XR PTA BALLOON FEMOR POPLITEAL

Facility

$8,843.05

Hospital Charge Code	5600006
Hospital Revenue Code	361
Min. Negotiated Rate	$1,149.60
Max. Negotiated Rate	$4,421.52
Rate for Payer: Aetna Commercial	$2,652.91
Rate for Payer: Aetna Medicare Advantage	$2,652.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,254.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,254.98
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	$2,254.98
Rate for Payer: Cigna Commercial	$4,421.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.46

XR PTA, BALLOON, ILIAC, BILAT

Facility

$21,962.30

Hospital Charge Code	2000843
Hospital Revenue Code	480
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR PTA, BALLOON, ILIAC, BILAT

Facility

$21,962.30

Hospital Charge Code	2000843
Hospital Revenue Code	480
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

XR PTA, BALLOON, ILIAC, BILAT

Facility

$21,962.30

Hospital Charge Code	2011175B
Hospital Revenue Code	360
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR PTA, BALLOON, ILIAC, BILAT

Facility

$21,962.30

Hospital Charge Code	2011175B
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR PTA EA ADD'L PERIPH ART

Facility

$1,547.25

Service Code	HCPCS 75964
Hospital Charge Code	2002533
Hospital Revenue Code	320
Min. Negotiated Rate	$201.14
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$464.18
Rate for Payer: Aetna Medicare Advantage	$464.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.55
Rate for Payer: Cigna Commercial	$773.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.14
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.09
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR PTA EA ADD'L PERIPH ART

Facility

$1,547.25

Service Code	HCPCS 75964
Hospital Charge Code	2002533
Hospital Revenue Code	320
Min. Negotiated Rate	$232.09
Max. Negotiated Rate	$232.09
Rate for Payer: Qualcare PPO/HMO/WC	$232.09

XR PTA EA ADD'L VISCERAL ARTER

Facility

$2,496.85

Service Code	HCPCS 75968
Hospital Charge Code	2002558
Hospital Revenue Code	320
Min. Negotiated Rate	$374.53
Max. Negotiated Rate	$374.53
Rate for Payer: Qualcare PPO/HMO/WC	$374.53

XR PTA EA ADD'L VISCERAL ARTER

Facility

$2,496.85

Service Code	HCPCS 75968
Hospital Charge Code	2002558
Hospital Revenue Code	320
Min. Negotiated Rate	$324.59
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$749.05
Rate for Payer: Aetna Medicare Advantage	$749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$636.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$636.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$636.70
Rate for Payer: Cigna Commercial	$1,248.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.59
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$374.53
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR PTA VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	2011179
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR PTA VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	2011179
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR PTC CATHETER INTRO

Facility

$13,811.90

Service Code	HCPCS 47510
Hospital Charge Code	2004489
Hospital Revenue Code	361
Min. Negotiated Rate	$1,795.55
Max. Negotiated Rate	$6,905.95
Rate for Payer: Aetna Commercial	$4,143.57
Rate for Payer: Aetna Medicare Advantage	$4,143.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,522.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,522.03
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	$3,522.03
Rate for Payer: Cigna Commercial	$6,905.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,795.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78

XR PTC CATHETER INTRO

Facility

$13,811.90

Service Code	HCPCS 47510
Hospital Charge Code	2004489
Hospital Revenue Code	361
Min. Negotiated Rate	$2,071.78
Max. Negotiated Rate	$2,071.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78

XR PYELOGRAM RETROGRADE

Facility

$5,100.00

Service Code	HCPCS 74420
Hospital Charge Code	2000750
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR PYELOGRAM RETROGRADE

Facility

$5,100.00

Service Code	HCPCS 74420
Hospital Charge Code	2000750
Hospital Revenue Code	320
Min. Negotiated Rate	$91.63
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR RADIOGRAPHIC ABSORPTINMETRY

Facility

$281.80

Hospital Charge Code	2011375
Hospital Revenue Code	320
Min. Negotiated Rate	$42.27
Max. Negotiated Rate	$42.27
Rate for Payer: Qualcare PPO/HMO/WC	$42.27

XR RADIOGRAPHIC ABSORPTINMETRY

Facility

$281.80

Hospital Charge Code	2011375
Hospital Revenue Code	320
Min. Negotiated Rate	$36.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$84.54
Rate for Payer: Aetna Medicare Advantage	$84.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.86
Rate for Payer: Cigna Commercial	$140.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.27
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR RANOREX/ORTHOPANTOGRAM

Facility

$258.70

Service Code	HCPCS 70355
Hospital Charge Code	2011370
Hospital Revenue Code	320
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR RANOREX/ORTHOPANTOGRAM

Facility

$258.70

Service Code	HCPCS 70355
Hospital Charge Code	2011370
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR REMOVAL OF KIDNEY STONE

Facility

$9,934.90

Service Code	HCPCS 50081
Hospital Charge Code	2011260
Hospital Revenue Code	361
Min. Negotiated Rate	$1,490.23
Max. Negotiated Rate	$1,490.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,490.23

XR REMOVAL OF KIDNEY STONE

Facility

$9,934.90

Service Code	HCPCS 50081
Hospital Charge Code	2011260
Hospital Revenue Code	361
Min. Negotiated Rate	$1,291.54
Max. Negotiated Rate	$22,543.37
Rate for Payer: Aetna Commercial	$2,980.47
Rate for Payer: Aetna Medicare Advantage	$2,980.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,533.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,533.40
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	$2,533.40
Rate for Payer: Cigna Commercial	$22,543.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,291.54
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,490.23
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

Know your out-of-pocket cost for care.

All Charges