Heights University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC LIMB

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270683900
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$7,048.50
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270683900
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB

Facility

$225.00

Service Code	HCPCS C1768
Hospital Charge Code	270679253
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

ILIAC LIMB

Facility

$225.00

Service Code	HCPCS C1768
Hospital Charge Code	270679253
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

ILIAC LIMB 10X 120MM

Facility

$23,495.00

Hospital Charge Code	270683415
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 10X 120MM

Facility

$23,495.00

Hospital Charge Code	270683415
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$7,048.50
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 22 X 120MM MM

Facility

$23,495.00

Hospital Charge Code	270683417
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 22 X 120MM MM

Facility

$23,495.00

Hospital Charge Code	270683417
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$7,048.50
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB EXTENSION

Facility

$21,145.00

Service Code	HCPCS C1768
Hospital Charge Code	270679763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,171.75
Max. Negotiated Rate	$10,572.50
Rate for Payer: Aetna Commercial	$6,343.50
Rate for Payer: Aetna Medicare Advantage	$6,343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,391.98
Rate for Payer: Cigna Commercial	$10,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,117.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,171.75

ILIAC LIMB EXTENSION

Facility

$21,145.00

Service Code	HCPCS C1768
Hospital Charge Code	270679763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,171.75
Max. Negotiated Rate	$5,117.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,117.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,171.75

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	7411800
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	2690505
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	7411800
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	2690505
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	41037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	321037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	41037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$6,732.42
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	2691340
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$6,732.42
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	366837222
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$6,732.42
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	321037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$6,732.42
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37222LT
Hospital Charge Code	7411920
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	2691340
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37222LT
Hospital Charge Code	7411920
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	366837222
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	2691345
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

Know your out-of-pocket cost for care.

All Charges