Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLSD TX TARSAL BONE W/MANIP

Facility

$645.00

Service Code	HCPCS 28455
Hospital Charge Code	5780100
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TX ULNR FRAC PRXM END WO

Facility

$6,152.64

Service Code	HCPCS 24675
Hospital Charge Code	16000686
Hospital Revenue Code	360
Min. Negotiated Rate	$799.84
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,845.79
Rate for Payer: Aetna Medicare Advantage	$1,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,568.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,568.92
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	$1,568.92
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.84
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$922.90
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CLSD TX ULNR FRAC PRXM END WO

Facility

$6,152.64

Service Code	HCPCS 24675
Hospital Charge Code	16000686
Hospital Revenue Code	360
Min. Negotiated Rate	$922.90
Max. Negotiated Rate	$922.90
Rate for Payer: Qualcare PPO/HMO/WC	$922.90

CLS ENTEROSTOMY LG/SM INTESTIN

Facility

$9,689.00

Service Code	HCPCS 44620
Hospital Charge Code	16000977
Hospital Revenue Code	360
Min. Negotiated Rate	$877.67
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$2,906.70
Rate for Payer: Aetna Medicare Advantage	$2,906.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,470.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,470.70
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	$2,470.70
Rate for Payer: Cigna Commercial	$877.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,259.57
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.35
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

CLS ENTEROSTOMY LG/SM INTESTIN

Facility

$9,689.00

Service Code	HCPCS 44620
Hospital Charge Code	16000977
Hospital Revenue Code	360
Min. Negotiated Rate	$1,453.35
Max. Negotiated Rate	$1,453.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.35

CLS ENTERSTMY,W RESECT&ANASTOM

Facility

$11,385.30

Service Code	HCPCS 44625
Hospital Charge Code	16000978
Hospital Revenue Code	360
Min. Negotiated Rate	$1,707.80
Max. Negotiated Rate	$1,707.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,707.80

CLS ENTERSTMY,W RESECT&ANASTOM

Facility

$11,385.30

Service Code	HCPCS 44625
Hospital Charge Code	16000978
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.64
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$3,415.59
Rate for Payer: Aetna Medicare Advantage	$3,415.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,903.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,903.25
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	$2,903.25
Rate for Payer: Cigna Commercial	$1,017.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.09
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,707.80
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

CL TX ARTCLR FX W/O MANIPUL

Facility

$645.00

Service Code	HCPCS 26740
Hospital Charge Code	5780075
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CL TX ARTCLR FX W/O MANIPUL

Facility

$645.00

Service Code	HCPCS 26740
Hospital Charge Code	5780075
Hospital Revenue Code	450
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CL TX ARTFX MCP/IP JNT; W MANI

Facility

$6,353.84

Service Code	HCPCS 26742
Hospital Charge Code	16000702
Hospital Revenue Code	360
Min. Negotiated Rate	$953.08
Max. Negotiated Rate	$953.08
Rate for Payer: Qualcare PPO/HMO/WC	$953.08

CL TX ARTFX MCP/IP JNT; W MANI

Facility

$6,353.84

Service Code	HCPCS 26742
Hospital Charge Code	16000702
Hospital Revenue Code	360
Min. Negotiated Rate	$826.00
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,906.15
Rate for Payer: Aetna Medicare Advantage	$1,906.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.23
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	$1,620.23
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$953.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CLTX BIMALLEOLAR ANKLE FRACT W

Facility

$6,728.28

Service Code	HCPCS 27810
Hospital Charge Code	16000629
Hospital Revenue Code	360
Min. Negotiated Rate	$1,009.24
Max. Negotiated Rate	$1,009.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24

CLTX BIMALLEOLAR ANKLE FRACT W

Facility

$6,728.28

Service Code	HCPCS 27810
Hospital Charge Code	16000629
Hospital Revenue Code	360
Min. Negotiated Rate	$874.68
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,018.48
Rate for Payer: Aetna Medicare Advantage	$2,018.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,715.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,715.71
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	$1,715.71
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.68
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CLTX BOMALLEOLAR ANKL FX WO M

Facility

$2,285.27

Service Code	HCPCS 27808
Hospital Charge Code	1600000542
Hospital Revenue Code	360
Min. Negotiated Rate	$297.09
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Better Health Medicaid	$708.84
Rate for Payer: Aetna Commercial	$685.58
Rate for Payer: Aetna Medicare Advantage	$685.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.74
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	$582.74
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.09
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.79
Rate for Payer: UnitedHealthcare Commercial	$1,686.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$708.84

CLTX BOMALLEOLAR ANKL FX WO M

Facility

$2,285.27

Service Code	HCPCS 27808
Hospital Charge Code	1600000542
Hospital Revenue Code	360
Min. Negotiated Rate	$342.79
Max. Negotiated Rate	$342.79
Rate for Payer: Qualcare PPO/HMO/WC	$342.79

CL TX CALCANEAL FX,W MANIP BL

Facility

$5,332.00

Service Code	HCPCS 28405
Hospital Charge Code	16000912
Hospital Revenue Code	360
Min. Negotiated Rate	$587.42
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,599.60
Rate for Payer: Aetna Medicare Advantage	$1,599.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,359.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,359.66
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	$1,359.66
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$693.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$799.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CL TX CALCANEAL FX,W MANIP BL

Facility

$5,332.00

Service Code	HCPCS 28405
Hospital Charge Code	16000912
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

CL TX CARPL SCAPHOID FX W MANI

Facility

$12,932.20

Service Code	HCPCS 25624
Hospital Charge Code	16000693
Hospital Revenue Code	360
Min. Negotiated Rate	$1,939.83
Max. Negotiated Rate	$1,939.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.83

CL TX CARPL SCAPHOID FX W MANI

Facility

$12,932.20

Service Code	HCPCS 25624
Hospital Charge Code	16000693
Hospital Revenue Code	360
Min. Negotiated Rate	$1,681.19
Max. Negotiated Rate	$3,879.66
Rate for Payer: Aetna Commercial	$3,879.66
Rate for Payer: Aetna Medicare Advantage	$3,879.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,297.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,297.71
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	$3,297.71
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.19
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.83
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CL TX DSTL RADLNR DISLC W MANP

Facility

$2,060.30

Service Code	HCPCS 25675
Hospital Charge Code	16000696
Hospital Revenue Code	360
Min. Negotiated Rate	$267.84
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$618.09
Rate for Payer: Aetna Medicare Advantage	$618.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$525.38
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	$525.38
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.84
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.05
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CL TX DSTL RADLNR DISLC W MANP

Facility

$2,060.30

Service Code	HCPCS 25675
Hospital Charge Code	16000696
Hospital Revenue Code	360
Min. Negotiated Rate	$309.05
Max. Negotiated Rate	$309.05
Rate for Payer: Qualcare PPO/HMO/WC	$309.05

CLTX DSTL RDL FX/EPIPHYSL SEP

Facility

$5,332.00

Service Code	HCPCS 25605
Hospital Charge Code	1600000561
Hospital Revenue Code	360
Min. Negotiated Rate	$693.16
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,599.60
Rate for Payer: Aetna Medicare Advantage	$1,599.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,359.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,359.66
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	$1,359.66
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$693.16
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$799.80
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CLTX DSTL RDL FX/EPIPHYSL SEP

Facility

$5,332.00

Service Code	HCPCS 25605
Hospital Charge Code	1600000561
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

CL TX FX GT PHALANX(S),W MANIP

Facility

$2,060.30

Service Code	HCPCS 28495
Hospital Charge Code	16000636
Hospital Revenue Code	360
Min. Negotiated Rate	$309.05
Max. Negotiated Rate	$309.05
Rate for Payer: Qualcare PPO/HMO/WC	$309.05

CL TX FX GT PHALANX(S),W MANIP

Facility

$2,060.30

Service Code	HCPCS 28495
Hospital Charge Code	16000636
Hospital Revenue Code	360
Min. Negotiated Rate	$267.84
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$618.09
Rate for Payer: Aetna Medicare Advantage	$618.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$525.38
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	$525.38
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.84
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.05
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges