Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	366837223L
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	$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	2691350
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	2691350
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	321037223L
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	366837223L
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	321037223L
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	7411923
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	321037223R
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	2691355
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	2691355
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	411037223R
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	7411923
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	411037223R
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	366837223R
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	321037223R
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-RT

Facility

$15,877.00

Service Code	HCPCS 37223RT
Hospital Charge Code	366837223R
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-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	2690500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$18,786.22
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,140.69
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	3668372215
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$18,786.22
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,140.69
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	321037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$31,310.36
Rate for Payer: Aetna Commercial	$18,786.22
Rate for Payer: Aetna Medicare Advantage	$18,786.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,968.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,968.28
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	$15,968.28
Rate for Payer: Cigna Commercial	$31,310.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,140.69
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	3668372215
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	2690500
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	411037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	321037221B
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

Know your out-of-pocket cost for care.

All Charges