Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	411036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	3668362475
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	321036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	2101168
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$5,218.20
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	321036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$5,218.20
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	3668362475
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$5,218.20
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	411036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$5,218.20
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	2101168
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	411036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	321036247L
Hospital Revenue Code	361
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	2101174
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	321036247L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	2101174
Hospital Revenue Code	361
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	2101173
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	321036247R
Hospital Revenue Code	361
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	321036247R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	2101173
Hospital Revenue Code	361
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$12,400.74

Service Code	HCPCS 36254
Hospital Charge Code	7411435
Hospital Revenue Code	361
Min. Negotiated Rate	$1,612.10
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$3,720.22
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
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	$3,162.19
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$12,400.74

Service Code	HCPCS 36254
Hospital Charge Code	7411435
Hospital Revenue Code	361
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$15,468.50

Service Code	HCPCS 36254
Hospital Charge Code	2670105
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$15,468.50

Service Code	HCPCS 36254
Hospital Charge Code	2670105
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$12,462.85

Service Code	HCPCS 36254
Hospital Charge Code	366836254
Hospital Revenue Code	361
Min. Negotiated Rate	$1,620.17
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$3,738.86
Rate for Payer: Aetna Medicare Advantage	$3,738.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,178.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,178.03
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	$3,178.03
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.17
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$12,462.85

Service Code	HCPCS 36254
Hospital Charge Code	411036254
Hospital Revenue Code	361
Min. Negotiated Rate	$1,620.17
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$3,738.86
Rate for Payer: Aetna Medicare Advantage	$3,738.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,178.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,178.03
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	$3,178.03
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.17
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$12,462.85

Service Code	HCPCS 36254
Hospital Charge Code	366836254
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

IR CATH PLCMNT RENAL ARTRY BIL

Facility

$12,462.85

Service Code	HCPCS 36254
Hospital Charge Code	411036254
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

Know your out-of-pocket cost for care.

All Charges