Heights University Hospital

All Charges

Charge

Type

Setting

Price

PT AQUATIC THRPY EA 15 MIN

Facility

$93.45

Service Code	HCPCS 97113GP
Hospital Charge Code	422597113
Hospital Revenue Code	420
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

PTA RENAL/VISCERAL ARTERY

Facility

$3,034.25

Service Code	HCPCS 35471
Hospital Charge Code	5100325
Hospital Revenue Code	761
Min. Negotiated Rate	$455.14
Max. Negotiated Rate	$455.14
Rate for Payer: Qualcare PPO/HMO/WC	$455.14

PTA RENAL/VISCERAL ARTERY

Facility

$3,034.25

Service Code	HCPCS 35471
Hospital Charge Code	5100325
Hospital Revenue Code	761
Min. Negotiated Rate	$394.45
Max. Negotiated Rate	$1,517.12
Rate for Payer: Aetna Commercial	$910.27
Rate for Payer: Aetna Medicare Advantage	$910.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$773.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$773.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$773.73
Rate for Payer: Cigna Commercial	$1,517.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$394.45
Rate for Payer: Oxford Commercial	$1,517.12
Rate for Payer: Qualcare PPO/HMO/WC	$455.14
Rate for Payer: UnitedHealthcare Commercial	$1,517.12

PTA RENAL/VISCERAL ARTERY S&I

Facility

$1,236.50

Service Code	HCPCS 75966
Hospital Charge Code	5100328
Hospital Revenue Code	320
Min. Negotiated Rate	$185.47
Max. Negotiated Rate	$185.47
Rate for Payer: Qualcare PPO/HMO/WC	$185.47

PTA RENAL/VISCERAL ARTERY S&I

Facility

$1,236.50

Service Code	HCPCS 75966
Hospital Charge Code	5100328
Hospital Revenue Code	320
Min. Negotiated Rate	$160.75
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$370.95
Rate for Payer: Aetna Medicare Advantage	$370.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.31
Rate for Payer: Cigna Commercial	$618.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.75
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.47
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	2690775
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 RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	2690775
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	7411843
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-BI

Facility

$6,122.00

Service Code	HCPCS 7596650
Hospital Charge Code	7411843
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 RNL OR VSCRL ARTRY-LT

Facility

$6,122.00

Service Code	HCPCS 75966LT
Hospital Charge Code	7412020
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,552.00

Service Code	HCPCS 75966LT
Hospital Charge Code	2691980
Hospital Revenue Code	320
Min. Negotiated Rate	$982.80
Max. Negotiated Rate	$982.80
Rate for Payer: Qualcare PPO/HMO/WC	$982.80

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,552.00

Service Code	HCPCS 75966LT
Hospital Charge Code	2691980
Hospital Revenue Code	320
Min. Negotiated Rate	$851.76
Max. Negotiated Rate	$3,276.00
Rate for Payer: Aetna Commercial	$1,965.60
Rate for Payer: Aetna Medicare Advantage	$1,965.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,670.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,670.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,670.76
Rate for Payer: Cigna Commercial	$3,276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.76
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$982.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PTA RNL OR VSCRL ARTRY-LT

Facility

$6,122.00

Service Code	HCPCS 75966LT
Hospital Charge Code	7412020
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 RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	7412021
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	2691985
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

PTA RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	2691985
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 RNL OR VSCRL ARTRY-RT

Facility

$6,122.00

Service Code	HCPCS 75966RT
Hospital Charge Code	7412021
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 ASSIST TECH ASSES EA 15 MIN

Facility

$164.00

Service Code	HCPCS 97755GP
Hospital Charge Code	422597755
Hospital Revenue Code	420
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$49.20
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
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	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT ASSIST TECH ASSES EA 15 MIN

Facility

$164.00

Service Code	HCPCS 97755GP
Hospital Charge Code	422597755
Hospital Revenue Code	420
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

PTA VENOUS

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5100334
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PTA VENOUS

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5100334
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

PTA VENOUS S&I

Facility

$1,151.85

Service Code	HCPCS 75978
Hospital Charge Code	5100329
Hospital Revenue Code	320
Min. Negotiated Rate	$172.78
Max. Negotiated Rate	$172.78
Rate for Payer: Qualcare PPO/HMO/WC	$172.78

PTA VENOUS S&I

Facility

$1,151.85

Service Code	HCPCS 75978
Hospital Charge Code	5100329
Hospital Revenue Code	320
Min. Negotiated Rate	$149.74
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$345.56
Rate for Payer: Aetna Medicare Advantage	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.72
Rate for Payer: Cigna Commercial	$575.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.74
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.78
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PTA VISCERL ARTERY EA ADDL S&I

Facility

$1,997.45

Service Code	HCPCS 75968
Hospital Charge Code	5100349
Hospital Revenue Code	320
Min. Negotiated Rate	$259.67
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$599.24
Rate for Payer: Aetna Medicare Advantage	$599.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$509.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$509.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$509.35
Rate for Payer: Cigna Commercial	$998.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.67
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$299.62
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PTA VISCERL ARTERY EA ADDL S&I

Facility

$1,997.45

Service Code	HCPCS 75968
Hospital Charge Code	5100349
Hospital Revenue Code	320
Min. Negotiated Rate	$299.62
Max. Negotiated Rate	$299.62
Rate for Payer: Qualcare PPO/HMO/WC	$299.62

Know your out-of-pocket cost for care.

All Charges