Heights University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	7411921
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-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	7411921
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-RT

Facility

$15,877.00

Service Code	HCPCS 37222RT
Hospital Charge Code	2691345
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,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	404637255
Hospital Revenue Code	481
Min. Negotiated Rate	$3,666.21
Max. Negotiated Rate	$3,666.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	403437255
Hospital Revenue Code	481
Min. Negotiated Rate	$3,666.21
Max. Negotiated Rate	$3,666.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	403437255
Hospital Revenue Code	481
Min. Negotiated Rate	$145.79
Max. Negotiated Rate	$7,332.42
Rate for Payer: Aetna Commercial	$7,332.42
Rate for Payer: Aetna Medicare Advantage	$7,332.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,232.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,232.56
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	$6,232.56
Rate for Payer: Cigna Commercial	$145.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,177.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21

ILIAC,PTA,ADDITIONAL

Facility

$24,441.40

Service Code	HCPCS 37255
Hospital Charge Code	404637255
Hospital Revenue Code	481
Min. Negotiated Rate	$145.79
Max. Negotiated Rate	$7,332.42
Rate for Payer: Aetna Commercial	$7,332.42
Rate for Payer: Aetna Medicare Advantage	$7,332.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,232.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,232.56
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	$6,232.56
Rate for Payer: Cigna Commercial	$145.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,177.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.21

ILIAC REVASC

Facility

$20,340.00

Service Code	HCPCS 37254
Hospital Charge Code	1600000629
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

ILIAC REVASC

Facility

$20,340.00

Service Code	HCPCS 37254
Hospital Charge Code	1600000629
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,553.85
Rate for Payer: Aetna Commercial	$6,102.00
Rate for Payer: Aetna Medicare Advantage	$6,102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,186.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,186.70
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	$5,186.70
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,644.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

ILIAC REVASC W/STENT-BI

Facility

$61,616.39

Service Code	HCPCS 3722150
Hospital Charge Code	7411139
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-BI

Facility

$61,616.39

Service Code	HCPCS 3722150
Hospital Charge Code	7411139
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	366837221L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	7411141
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	7411141
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	366837221L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	366837221R
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	7411143
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	7411143
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	366837221R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC STENT W/PTA ADD-BI

Facility

$15,877.00

Service Code	HCPCS 3722350
Hospital Charge Code	7411801
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 STENT W/PTA ADD-BI

Facility

$15,877.00

Service Code	HCPCS 3722350
Hospital Charge Code	2690510
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 STENT W/PTA ADD-BI

Facility

$15,877.00

Service Code	HCPCS 3722350
Hospital Charge Code	2690510
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 STENT W/PTA ADD-BI

Facility

$15,877.00

Service Code	HCPCS 3722350
Hospital Charge Code	7411801
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 STENT W/PTA ADD-LT

Facility

$15,877.00

Service Code	HCPCS 37223LT
Hospital Charge Code	7411922
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 STENT W/PTA ADD-LT

Facility

$15,877.00

Service Code	HCPCS 37223LT
Hospital Charge Code	411037223L
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

Know your out-of-pocket cost for care.

All Charges