Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR PTA PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011180
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 PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	7411736
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 PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	2011180
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 PERPHRAL ARTRY OTHER S&

Facility

$21,962.30

Service Code	HCPCS 75962
Hospital Charge Code	7411736
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 RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	2011288
Hospital Revenue Code	320
Min. Negotiated Rate	$342.37
Max. Negotiated Rate	$342.37
Rate for Payer: Qualcare PPO/HMO/WC	$342.37

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	7411740
Hospital Revenue Code	320
Min. Negotiated Rate	$342.37
Max. Negotiated Rate	$342.37
Rate for Payer: Qualcare PPO/HMO/WC	$342.37

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	2011288
Hospital Revenue Code	320
Min. Negotiated Rate	$296.72
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$684.74
Rate for Payer: Aetna Medicare Advantage	$684.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$582.02
Rate for Payer: Cigna Commercial	$1,141.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR PTA RENAL OR VISCERAL EA AD

Facility

$2,282.45

Service Code	HCPCS 75968
Hospital Charge Code	7411740
Hospital Revenue Code	320
Min. Negotiated Rate	$296.72
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$684.74
Rate for Payer: Aetna Medicare Advantage	$684.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$582.02
Rate for Payer: Cigna Commercial	$1,141.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR PTA RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	5100355
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 RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	5100355
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 RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	7411739
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 RENAL OR VISCERAL INIT

Facility

$21,962.30

Service Code	HCPCS 75966
Hospital Charge Code	7411739
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 TIBIO ARTERY & BRANCHES

Facility

$10,595.00

Service Code	HCPCS 35470
Hospital Charge Code	2680150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,377.35
Max. Negotiated Rate	$5,297.50
Rate for Payer: Aetna Commercial	$3,178.50
Rate for Payer: Aetna Medicare Advantage	$3,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,701.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,701.72
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	$2,701.72
Rate for Payer: Cigna Commercial	$5,297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,377.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,589.25

IR-PTA TIBIO ARTERY & BRANCHES

Facility

$10,595.00

Service Code	HCPCS 35470
Hospital Charge Code	2680150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,589.25
Max. Negotiated Rate	$1,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,589.25

IR PTA VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	2011173
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 VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	7411410
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 VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	2011173
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 VENOUS

Facility

$6,273.80

Service Code	HCPCS 75978
Hospital Charge Code	2001627
Hospital Revenue Code	320
Min. Negotiated Rate	$815.59
Max. Negotiated Rate	$3,136.90
Rate for Payer: Aetna Commercial	$1,882.14
Rate for Payer: Aetna Medicare Advantage	$1,882.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,599.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,599.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,599.82
Rate for Payer: Cigna Commercial	$3,136.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.59
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$941.07
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR PTA VENOUS

Facility

$6,273.80

Service Code	HCPCS 75978
Hospital Charge Code	2001627
Hospital Revenue Code	320
Min. Negotiated Rate	$941.07
Max. Negotiated Rate	$941.07
Rate for Payer: Qualcare PPO/HMO/WC	$941.07

IR PTA VENOUS

Facility

$21,962.30

Service Code	HCPCS 35476
Hospital Charge Code	7411410
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 PTC STENT INTRO INT/EXT DRN

Facility

$13,811.90

Hospital Charge Code	2004471
Hospital Revenue Code	361
Min. Negotiated Rate	$1,795.55
Max. Negotiated Rate	$6,905.95
Rate for Payer: Aetna Commercial	$4,143.57
Rate for Payer: Aetna Medicare Advantage	$4,143.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,522.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,522.03
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	$3,522.03
Rate for Payer: Cigna Commercial	$6,905.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,795.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78

IR PTC STENT INTRO INT/EXT DRN

Facility

$13,811.90

Hospital Charge Code	2004471
Hospital Revenue Code	361
Min. Negotiated Rate	$2,071.78
Max. Negotiated Rate	$2,071.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,071.78

IR PTC W/DRAINAGE

Facility

$2,516.85

Service Code	HCPCS 75980
Hospital Charge Code	2001626
Hospital Revenue Code	320
Min. Negotiated Rate	$377.53
Max. Negotiated Rate	$377.53
Rate for Payer: Qualcare PPO/HMO/WC	$377.53

IR PTC W/DRAINAGE

Facility

$2,516.85

Service Code	HCPCS 75980
Hospital Charge Code	2001626
Hospital Revenue Code	320
Min. Negotiated Rate	$327.19
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$755.05
Rate for Payer: Aetna Medicare Advantage	$755.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$641.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$641.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$641.80
Rate for Payer: Cigna Commercial	$1,258.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.19
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$377.53
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR PULMONARY ARTERY CATH INTRO

Facility

$414.45

Service Code	HCPCS 36013
Hospital Charge Code	7411417
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

Know your out-of-pocket cost for care.

All Charges