Heights University Hospital

All Charges

Charge

Type

Setting

Price

PTA BRACHIOCEPHALIC

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5100510
Hospital Revenue Code	761
Min. Negotiated Rate	$735.74
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$1,697.87
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.74
Rate for Payer: Oxford Commercial	$2,829.78
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Commercial	$2,829.78

PT ADD WALKER TO CAST

Facility

$468.75

Service Code	HCPCS 29440GP
Hospital Charge Code	422529440
Hospital Revenue Code	420
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

PT ADD WALKER TO CAST

Facility

$468.75

Service Code	HCPCS 29440GP
Hospital Charge Code	422529440
Hospital Revenue Code	420
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$140.62
Rate for Payer: Aetna Medicare Advantage	$140.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.53
Rate for Payer: Cigna Commercial	$234.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.94
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GP
Hospital Charge Code	9000084
Hospital Revenue Code	420
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GP
Hospital Charge Code	9000084
Hospital Revenue Code	420
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$42.49
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.41
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT ADL SESSION EA 15 MIN

Facility

$169.00

Service Code	HCPCS 97535
Hospital Charge Code	409297535
Hospital Revenue Code	420
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

PT ADL SESSION EA 15 MIN

Facility

$169.00

Service Code	HCPCS 97535
Hospital Charge Code	409297535
Hospital Revenue Code	420
Min. Negotiated Rate	$21.97
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$50.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.09
Rate for Payer: Cigna Commercial	$36.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.97
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 7596850
Hospital Charge Code	7412022
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 75968LT
Hospital Charge Code	2691990
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 7596850
Hospital Charge Code	7412022
Hospital Revenue Code	320
Min. Negotiated Rate	$795.86
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$1,836.60
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$795.86
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PT AD RNL OR VSCRL ART-BI

Facility

$6,122.00

Service Code	HCPCS 75968LT
Hospital Charge Code	2691990
Hospital Revenue Code	320
Min. Negotiated Rate	$795.86
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$1,836.60
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$795.86
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PTA FEMORAL POPLITEAL

Facility

$5,659.55

Service Code	HCPCS 35474
Hospital Charge Code	5100333
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PTA FEMORAL POPLITEAL

Facility

$5,659.55

Service Code	HCPCS 35474
Hospital Charge Code	5100333
Hospital Revenue Code	761
Min. Negotiated Rate	$735.74
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$1,697.87
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.74
Rate for Payer: Oxford Commercial	$2,829.78
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Commercial	$2,829.78

PTAH STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005312
Hospital Revenue Code	310
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

PTAH STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005312
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	5100330
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

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	74110039
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

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	5100330
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

PTA ILIAC ARTERY

Facility

$21,962.30

Hospital Charge Code	74110039
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

PT-AMBULATION CLASS DBL*****

Facility

$96.00

Hospital Charge Code	9000100
Hospital Revenue Code	429
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

PT-AMBULATION CLASS DBL*****

Facility

$96.00

Hospital Charge Code	9000100
Hospital Revenue Code	429
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$686.00

PTA PERIPH ARTERY EA ADDL S&I

Facility

$1,237.80

Service Code	HCPCS 75964
Hospital Charge Code	5100348
Hospital Revenue Code	320
Min. Negotiated Rate	$185.67
Max. Negotiated Rate	$185.67
Rate for Payer: Qualcare PPO/HMO/WC	$185.67

PTA PERIPH ARTERY EA ADDL S&I

Facility

$1,237.80

Service Code	HCPCS 75964
Hospital Charge Code	5100348
Hospital Revenue Code	320
Min. Negotiated Rate	$160.91
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$371.34
Rate for Payer: Aetna Medicare Advantage	$371.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.64
Rate for Payer: Cigna Commercial	$618.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.91
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.67
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PTA PERIPH ARTERY S&I

Facility

$1,742.10

Service Code	HCPCS 75962
Hospital Charge Code	5100320
Hospital Revenue Code	320
Min. Negotiated Rate	$261.31
Max. Negotiated Rate	$261.31
Rate for Payer: Qualcare PPO/HMO/WC	$261.31

PTA PERIPH ARTERY S&I

Facility

$1,742.10

Service Code	HCPCS 75962
Hospital Charge Code	5100320
Hospital Revenue Code	320
Min. Negotiated Rate	$226.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$522.63
Rate for Payer: Aetna Medicare Advantage	$522.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$444.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$444.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$444.24
Rate for Payer: Cigna Commercial	$871.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.31
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges