Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR REMOVE RENAL TUBE W/FLUORO

Facility

$3,274.65

Service Code	HCPCS 50389
Hospital Charge Code	5600169
Hospital Revenue Code	361
Min. Negotiated Rate	$425.70
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$982.39
Rate for Payer: Aetna Medicare Advantage	$982.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.04
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	$835.04
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$491.20
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR REMOVE RENAL TUBE W/FLUORO

Facility

$3,274.65

Service Code	HCPCS 50389
Hospital Charge Code	5600169
Hospital Revenue Code	361
Min. Negotiated Rate	$491.20
Max. Negotiated Rate	$491.20
Rate for Payer: Qualcare PPO/HMO/WC	$491.20

XR REMOVE URETER STENT PERC

Facility

$8,535.00

Service Code	HCPCS 50384
Hospital Charge Code	5600168
Hospital Revenue Code	361
Min. Negotiated Rate	$1,109.55
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,560.50
Rate for Payer: Aetna Medicare Advantage	$2,560.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,176.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,176.43
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	$2,176.43
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.55
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

XR REMOVE URETER STENT PERC

Facility

$8,535.00

Service Code	HCPCS 50384
Hospital Charge Code	5600168
Hospital Revenue Code	361
Min. Negotiated Rate	$1,280.25
Max. Negotiated Rate	$1,280.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25

XR REPAIR ARTERIAL BLOCK (TUB)

Facility

$14,067.00

Service Code	HCPCS 35459
Hospital Charge Code	2011283
Hospital Revenue Code	761
Min. Negotiated Rate	$2,110.05
Max. Negotiated Rate	$2,110.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,110.05

XR REPAIR ARTERIAL BLOCK (TUB)

Facility

$14,067.00

Service Code	HCPCS 35459
Hospital Charge Code	2011283
Hospital Revenue Code	761
Min. Negotiated Rate	$1,828.71
Max. Negotiated Rate	$7,033.50
Rate for Payer: Aetna Commercial	$4,220.10
Rate for Payer: Aetna Medicare Advantage	$4,220.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,587.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,587.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,587.09
Rate for Payer: Cigna Commercial	$7,033.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,828.71
Rate for Payer: Oxford Commercial	$7,033.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,110.05
Rate for Payer: UnitedHealthcare Commercial	$7,033.50

XR REPAIR TUNNELED CV CATH

Facility

$2,087.20

Service Code	HCPCS 36575
Hospital Charge Code	7411462
Hospital Revenue Code	361
Min. Negotiated Rate	$271.34
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$626.16
Rate for Payer: Aetna Medicare Advantage	$626.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.24
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	$532.24
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.34
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.08
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR REPAIR TUNNELED CV CATH

Facility

$2,087.20

Service Code	HCPCS 36575
Hospital Charge Code	7411462
Hospital Revenue Code	361
Min. Negotiated Rate	$313.08
Max. Negotiated Rate	$313.08
Rate for Payer: Qualcare PPO/HMO/WC	$313.08

XR REPAIR TUNNELED CV CATH

Facility

$2,087.20

Service Code	HCPCS 36575
Hospital Charge Code	5600131
Hospital Revenue Code	361
Min. Negotiated Rate	$271.34
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$626.16
Rate for Payer: Aetna Medicare Advantage	$626.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.24
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	$532.24
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.34
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.08
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR REPAIR TUNNELED CV CATH

Facility

$2,087.20

Service Code	HCPCS 36575
Hospital Charge Code	5600131
Hospital Revenue Code	361
Min. Negotiated Rate	$313.08
Max. Negotiated Rate	$313.08
Rate for Payer: Qualcare PPO/HMO/WC	$313.08

XR REPALCE TUN CV CATH W PUMP

Facility

$11,315.45

Service Code	HCPCS 36578
Hospital Charge Code	411093600
Hospital Revenue Code	481
Min. Negotiated Rate	$1,471.01
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$3,394.64
Rate for Payer: Aetna Medicare Advantage	$3,394.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,885.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,885.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,885.44
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,471.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

XR REPALCE TUN CV CATH W PUMP

Facility

$11,315.45

Service Code	HCPCS 36578
Hospital Charge Code	5600132
Hospital Revenue Code	361
Min. Negotiated Rate	$1,697.32
Max. Negotiated Rate	$1,697.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32

XR REPALCE TUN CV CATH W PUMP

Facility

$11,315.45

Service Code	HCPCS 36578
Hospital Charge Code	411093600
Hospital Revenue Code	481
Min. Negotiated Rate	$1,697.32
Max. Negotiated Rate	$1,697.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32

XR REPALCE TUN CV CATH W PUMP

Facility

$11,315.45

Service Code	HCPCS 36578
Hospital Charge Code	5600132
Hospital Revenue Code	361
Min. Negotiated Rate	$1,471.01
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$3,394.64
Rate for Payer: Aetna Medicare Advantage	$3,394.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,885.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,885.44
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	$2,885.44
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,471.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

XR REPALCE TUN CV CATH W PUMP

Facility

$11,315.45

Service Code	HCPCS 36578
Hospital Charge Code	7411464
Hospital Revenue Code	361
Min. Negotiated Rate	$1,471.01
Max. Negotiated Rate	$7,519.21
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Aetna Commercial	$3,394.64
Rate for Payer: Aetna Medicare Advantage	$3,394.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,885.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,885.44
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	$2,885.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,471.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

XR REPALCE TUN CV CATH W PUMP

Facility

$11,315.45

Service Code	HCPCS 36578
Hospital Charge Code	7411464
Hospital Revenue Code	361
Min. Negotiated Rate	$1,697.32
Max. Negotiated Rate	$1,697.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32

XR REPEAT GB GRANULES

Facility

$463.25

Service Code	HCPCS 74291
Hospital Charge Code	2000297
Hospital Revenue Code	320
Min. Negotiated Rate	$69.49
Max. Negotiated Rate	$69.49
Rate for Payer: Qualcare PPO/HMO/WC	$69.49

XR REPEAT GB GRANULES

Facility

$463.25

Service Code	HCPCS 74291
Hospital Charge Code	2000297
Hospital Revenue Code	320
Min. Negotiated Rate	$60.22
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$138.97
Rate for Payer: Aetna Medicare Advantage	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.13
Rate for Payer: Cigna Commercial	$231.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.49
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR REPLACE DUOD/JEJ TUBE PERC

Facility

$4,459.55

Service Code	HCPCS 49451
Hospital Charge Code	321049451
Hospital Revenue Code	361
Min. Negotiated Rate	$579.74
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,337.87
Rate for Payer: Aetna Medicare Advantage	$1,337.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.19
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	$1,137.19
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.74
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$668.93
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR REPLACE DUOD/JEJ TUBE PERC

Facility

$4,459.55

Service Code	HCPCS 49451
Hospital Charge Code	5600164
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

XR REPLACE DUOD/JEJ TUBE PERC

Facility

$4,459.55

Service Code	HCPCS 49451
Hospital Charge Code	321049451
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

XR REPLACE DUOD/JEJ TUBE PERC

Facility

$4,459.55

Service Code	HCPCS 49451
Hospital Charge Code	5600164
Hospital Revenue Code	361
Min. Negotiated Rate	$579.74
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,337.87
Rate for Payer: Aetna Medicare Advantage	$1,337.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.19
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	$1,137.19
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.74
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$668.93
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR REPLACE G/C TUBE PERC

Facility

$2,087.20

Service Code	HCPCS 49450
Hospital Charge Code	5600163
Hospital Revenue Code	361
Min. Negotiated Rate	$271.34
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$626.16
Rate for Payer: Aetna Medicare Advantage	$626.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.24
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	$532.24
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.34
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.08
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR REPLACE G/C TUBE PERC

Facility

$2,087.20

Service Code	HCPCS 49450
Hospital Charge Code	5600163
Hospital Revenue Code	361
Min. Negotiated Rate	$313.08
Max. Negotiated Rate	$313.08
Rate for Payer: Qualcare PPO/HMO/WC	$313.08

XR REPLACE G-J TUBE

Facility

$2,087.20

Service Code	HCPCS 49452
Hospital Charge Code	5600165
Hospital Revenue Code	361
Min. Negotiated Rate	$313.08
Max. Negotiated Rate	$313.08
Rate for Payer: Qualcare PPO/HMO/WC	$313.08

Know your out-of-pocket cost for care.

All Charges