Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	321036002R
Hospital Revenue Code	361
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	2691140
Hospital Revenue Code	361
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR-PSEUDOAN INJ-RT

Facility

$610.00

Service Code	HCPCS 36002RT
Hospital Charge Code	7411894
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	2691140
Hospital Revenue Code	361
Min. Negotiated Rate	$471.99
Max. Negotiated Rate	$1,864.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: Aetna Commercial	$1,089.21
Rate for Payer: Aetna Medicare Advantage	$1,089.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.83
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	$925.83
Rate for Payer: Cigna Commercial	$1,815.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.99

IR-PSEUDOAN INJ-RT

Facility

$610.00

Service Code	HCPCS 36002RT
Hospital Charge Code	7411894
Hospital Revenue Code	761
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$305.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$305.00

IR PTA BALLOON AORTIC

Facility

$7,074.45

Service Code	HCPCS 35472
Hospital Charge Code	2000844
Hospital Revenue Code	361
Min. Negotiated Rate	$1,061.17
Max. Negotiated Rate	$1,061.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.17

IR PTA BALLOON AORTIC

Facility

$7,074.45

Service Code	HCPCS 35472
Hospital Charge Code	2000844
Hospital Revenue Code	361
Min. Negotiated Rate	$919.68
Max. Negotiated Rate	$3,537.22
Rate for Payer: Aetna Commercial	$2,122.34
Rate for Payer: Aetna Medicare Advantage	$2,122.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.98
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	$1,803.98
Rate for Payer: Cigna Commercial	$3,537.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.17

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	2000846
Hospital Revenue Code	361
Min. Negotiated Rate	$3,313.09
Max. Negotiated Rate	$3,313.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	7411408
Hospital Revenue Code	361
Min. Negotiated Rate	$3,313.09
Max. Negotiated Rate	$3,313.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	2000846
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,043.65
Rate for Payer: Aetna Commercial	$6,626.19
Rate for Payer: Aetna Medicare Advantage	$6,626.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,632.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,632.26
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	$5,632.26
Rate for Payer: Cigna Commercial	$11,043.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,871.35
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	7411408
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,043.65
Rate for Payer: Aetna Commercial	$6,626.19
Rate for Payer: Aetna Medicare Advantage	$6,626.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,632.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,632.26
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	$5,632.26
Rate for Payer: Cigna Commercial	$11,043.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,871.35
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175A
Hospital Revenue Code	360
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175A
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC UNILAT

Facility

$21,962.30

Hospital Charge Code	2011170
Hospital Revenue Code	480
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC UNILAT

Facility

$21,962.30

Hospital Charge Code	2011170
Hospital Revenue Code	480
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	2000845
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	2000845
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	7411406
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON RENAL OR VIS EA

Facility

$21,962.30

Service Code	HCPCS 35471
Hospital Charge Code	7411406
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA ILIAC ART BILAT

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011185
Hospital Revenue Code	320
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA ILIAC ART BILAT

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011185
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR-PTA ILIAC ARTERY

Facility

$21,962.00

Service Code	HCPCS 35473
Hospital Charge Code	2680155
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.30
Max. Negotiated Rate	$3,294.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.30

IR-PTA ILIAC ARTERY

Facility

$21,962.00

Service Code	HCPCS 35473
Hospital Charge Code	2680155
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.00
Rate for Payer: Aetna Commercial	$6,588.60
Rate for Payer: Aetna Medicare Advantage	$6,588.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.31
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	$5,600.31
Rate for Payer: Cigna Commercial	$10,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.30

Know your out-of-pocket cost for care.

All Charges