Heights University Hospital

All Charges

Charge

Type

Setting

Price

OPEN LAT RETINA RELEASE

Facility

$30,595.00

Service Code	HCPCS 27425
Hospital Charge Code	16000509
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

OPEN/PERQ PLACE STENT 1ST

Facility

$52,548.60

Service Code	HCPCS 37236
Hospital Charge Code	366837236
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$15,764.58
Rate for Payer: Aetna Medicare Advantage	$15,764.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,399.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,399.89
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	$13,399.89
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,831.32
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

OPEN/PERQ PLACE STENT 1ST

Facility

$52,548.60

Service Code	HCPCS 37236
Hospital Charge Code	411037236
Hospital Revenue Code	361
Min. Negotiated Rate	$7,882.29
Max. Negotiated Rate	$7,882.29
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

OPEN/PERQ PLACE STENT 1ST

Facility

$42,041.84

Service Code	HCPCS 37236
Hospital Charge Code	1600000351
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$12,612.55
Rate for Payer: Aetna Medicare Advantage	$12,612.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,720.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,720.67
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	$10,720.67
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,465.44
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,306.28
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

OPEN/PERQ PLACE STENT 1ST

Facility

$42,041.84

Service Code	HCPCS 37236
Hospital Charge Code	1600000351
Hospital Revenue Code	360
Min. Negotiated Rate	$6,306.28
Max. Negotiated Rate	$6,306.28
Rate for Payer: Qualcare PPO/HMO/WC	$6,306.28

OPEN/PERQ PLACE STENT 1ST

Facility

$52,548.60

Service Code	HCPCS 37236
Hospital Charge Code	366837236
Hospital Revenue Code	361
Min. Negotiated Rate	$7,882.29
Max. Negotiated Rate	$7,882.29
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

OPEN/PERQ PLACE STENT 1ST

Facility

$52,548.60

Service Code	HCPCS 37236
Hospital Charge Code	411037236
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$15,764.58
Rate for Payer: Aetna Medicare Advantage	$15,764.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,399.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,399.89
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	$13,399.89
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,831.32
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	411037237
Hospital Revenue Code	361
Min. Negotiated Rate	$201.26
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$4,684.50
Rate for Payer: Aetna Medicare Advantage	$4,684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,981.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,981.82
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	$3,981.82
Rate for Payer: Cigna Commercial	$201.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,029.95
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	7411527
Hospital Revenue Code	361
Min. Negotiated Rate	$3,928.82
Max. Negotiated Rate	$3,928.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	7411527
Hospital Revenue Code	361
Min. Negotiated Rate	$141.45
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$7,857.63
Rate for Payer: Aetna Medicare Advantage	$7,857.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.99
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	$6,678.99
Rate for Payer: Cigna Commercial	$141.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,404.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	411037239
Hospital Revenue Code	361
Min. Negotiated Rate	$3,928.82
Max. Negotiated Rate	$3,928.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82

OPEN/PERQ PLACE STENT EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	366837237
Hospital Revenue Code	361
Min. Negotiated Rate	$201.26
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$4,684.50
Rate for Payer: Aetna Medicare Advantage	$4,684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,981.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,981.82
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	$3,981.82
Rate for Payer: Cigna Commercial	$201.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,029.95
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	411037239
Hospital Revenue Code	361
Min. Negotiated Rate	$141.45
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$7,857.63
Rate for Payer: Aetna Medicare Advantage	$7,857.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.99
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	$6,678.99
Rate for Payer: Cigna Commercial	$141.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,404.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	321037239
Hospital Revenue Code	361
Min. Negotiated Rate	$3,928.82
Max. Negotiated Rate	$3,928.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	5700319
Hospital Revenue Code	361
Min. Negotiated Rate	$3,928.82
Max. Negotiated Rate	$3,928.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	321037239
Hospital Revenue Code	361
Min. Negotiated Rate	$141.45
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$7,857.63
Rate for Payer: Aetna Medicare Advantage	$7,857.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.99
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	$6,678.99
Rate for Payer: Cigna Commercial	$141.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,404.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	5700319
Hospital Revenue Code	361
Min. Negotiated Rate	$141.45
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$7,857.63
Rate for Payer: Aetna Medicare Advantage	$7,857.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.99
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	$6,678.99
Rate for Payer: Cigna Commercial	$141.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,404.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	366837239
Hospital Revenue Code	361
Min. Negotiated Rate	$141.45
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$7,857.63
Rate for Payer: Aetna Medicare Advantage	$7,857.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.99
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	$6,678.99
Rate for Payer: Cigna Commercial	$141.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,404.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN/PERQ PLACE STENT EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	366837237
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.25
Max. Negotiated Rate	$2,342.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25

OPEN/PERQ PLACE STENT EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	411037237
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.25
Max. Negotiated Rate	$2,342.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25

OPEN/PERQ PLACE STENT EA ADD

Facility

$26,192.10

Service Code	HCPCS 37239
Hospital Charge Code	366837239
Hospital Revenue Code	361
Min. Negotiated Rate	$3,928.82
Max. Negotiated Rate	$3,928.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,928.82

OPEN/PERQ PLACE STENT SAME

Facility

$54,159.16

Service Code	HCPCS 37238
Hospital Charge Code	366837238
Hospital Revenue Code	361
Min. Negotiated Rate	$8,123.87
Max. Negotiated Rate	$8,123.87
Rate for Payer: Qualcare PPO/HMO/WC	$8,123.87

OPEN/PERQ PLACE STENT SAME

Facility

$54,159.16

Service Code	HCPCS 37238
Hospital Charge Code	7411526
Hospital Revenue Code	361
Min. Negotiated Rate	$8,123.87
Max. Negotiated Rate	$8,123.87
Rate for Payer: Qualcare PPO/HMO/WC	$8,123.87

OPEN/PERQ PLACE STENT SAME

Facility

$54,159.16

Service Code	HCPCS 37238
Hospital Charge Code	366837238
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$16,247.75
Rate for Payer: Aetna Medicare Advantage	$16,247.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,810.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,810.59
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	$13,810.59
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,040.69
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,123.87
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

OPEN/PERQ PLACE STENT SAME

Facility

$54,159.16

Service Code	HCPCS 37238
Hospital Charge Code	411037238
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$16,247.75
Rate for Payer: Aetna Medicare Advantage	$16,247.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,810.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,810.59
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	$13,810.59
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,040.69
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,123.87
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

Know your out-of-pocket cost for care.

All Charges