Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	7411439
Hospital Revenue Code	361
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Medicare Advantage	$20.62
Rate for Payer: Aetna Commercial	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.53
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	$17.53
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	5600030
Hospital Revenue Code	361
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$20.62
Rate for Payer: Aetna Medicare Advantage	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.53
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	$17.53
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	5600030
Hospital Revenue Code	361
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	7411495
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	5600143MF
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	5600143MF
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	7411495
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR VENOGRAM LOWER XTRMITY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011416
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM LOWER XTRMITY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011416
Hospital Revenue Code	320
Min. Negotiated Rate	$117.14
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$671.26
Rate for Payer: Aetna Medicare Advantage	$671.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.58
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR VENOGRAM LOWER XTRMITY RGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011417
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM LOWER XTRMITY RGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011417
Hospital Revenue Code	320
Min. Negotiated Rate	$117.14
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$671.26
Rate for Payer: Aetna Medicare Advantage	$671.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.58
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR VENOGRAM LWR XTRMTY BILATRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011415
Hospital Revenue Code	320
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$671.26
Rate for Payer: Aetna Medicare Advantage	$671.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.58
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR VENOGRAM LWR XTRMTY BILATRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011415
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPER XTRMTY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011419
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPER XTRMTY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011419
Hospital Revenue Code	320
Min. Negotiated Rate	$117.14
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$671.26
Rate for Payer: Aetna Medicare Advantage	$671.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.58
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR VENOGRAM UPPER XTRMTY RIGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011420
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPER XTRMTY RIGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011420
Hospital Revenue Code	320
Min. Negotiated Rate	$117.14
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$671.26
Rate for Payer: Aetna Medicare Advantage	$671.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.58
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR VENOGRAM UPPR XTRMTY BILTRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011418
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPR XTRMTY BILTRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011418
Hospital Revenue Code	320
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$671.26
Rate for Payer: Aetna Medicare Advantage	$671.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.58
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR VENOUS MECH THROMBECTOMY

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	7411496
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR VENOUS MECH THROMBECTOMY

Facility

$27,397.00

Service Code	HCPCS 37187
Hospital Charge Code	321037187
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

XR VENOUS MECH THROMBECTOMY

Facility

$25,423.30

Service Code	HCPCS 37187
Hospital Charge Code	411037187
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$7,626.99
Rate for Payer: Aetna Medicare Advantage	$7,626.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,482.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,482.94
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	$6,482.94
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,305.03
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR VENOUS MECH THROMBECTOMY

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	7411496
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VENOUS MECH THROMBECTOMY

Facility

$27,397.00

Service Code	HCPCS 37187
Hospital Charge Code	5600143
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$8,219.10
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
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	$6,986.23
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,561.61
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR VENOUS MECH THROMBECTOMY

Facility

$27,397.00

Service Code	HCPCS 37187
Hospital Charge Code	321037187
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$8,219.10
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
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	$6,986.23
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,561.61
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges