Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	411037232R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	366837232R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	321037232R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	7411943
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	2691455
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$4,763.10
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIBPER REVASC W/ATHER ADD-ON

Facility

$6,275.44

Service Code	HCPCS 37289
Hospital Charge Code	404637289
Hospital Revenue Code	481
Min. Negotiated Rate	$941.32
Max. Negotiated Rate	$941.32
Rate for Payer: Qualcare PPO/HMO/WC	$941.32

TIBPER REVASC W/ATHER ADD-ON

Facility

$6,275.44

Service Code	HCPCS 37289
Hospital Charge Code	404637289
Hospital Revenue Code	481
Min. Negotiated Rate	$230.64
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$1,882.63
Rate for Payer: Aetna Medicare Advantage	$1,882.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.24
Rate for Payer: Cigna Commercial	$230.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.81
Rate for Payer: Qualcare PPO/HMO/WC	$941.32

TIB/PER REVASC W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3723050
Hospital Charge Code	7411809
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-BI

Facility

$33,710.00

Service Code	HCPCS 3723050
Hospital Charge Code	2690550
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$16,855.00
Rate for Payer: Aetna Commercial	$10,113.00
Rate for Payer: Aetna Medicare Advantage	$10,113.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,596.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,596.05
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	$8,596.05
Rate for Payer: Cigna Commercial	$16,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,382.30
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50

TIB/PER REVASC W/STENT-BI

Facility

$33,710.00

Service Code	HCPCS 3723050
Hospital Charge Code	2690550
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.50
Max. Negotiated Rate	$5,056.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50

TIB/PER REVASC W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3723050
Hospital Charge Code	7411809
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	366837230L
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	2691430
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	2691430
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	366837230L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	7411938
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	321037230L
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	321037230L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	7411938
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	2691435
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	411037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$33,710.00

Service Code	HCPCS 37230RT
Hospital Charge Code	7411939
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$16,855.00
Rate for Payer: Aetna Commercial	$10,113.00
Rate for Payer: Aetna Medicare Advantage	$10,113.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,596.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,596.05
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	$8,596.05
Rate for Payer: Cigna Commercial	$16,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,382.30
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.50

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	411037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	321037230R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-RT

Facility

$93,917.89

Service Code	HCPCS 37230RT
Hospital Charge Code	366837230R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$28,175.37
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,209.33
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

Know your out-of-pocket cost for care.

All Charges