Heights University Hospital

All Charges

Charge

Type

Setting

Price

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$31,803.54

Service Code	MSDRG 921
Min. Negotiated Rate	$7,512.22
Max. Negotiated Rate	$31,803.54
Rate for Payer: Aetna Commercial	$23,212.76
Rate for Payer: Aetna Medicare Advantage	$7,512.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,296.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,296.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,601.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,296.90
Rate for Payer: Cigna Commercial	$14,815.06
Rate for Payer: Cigna Medicare Advantage	$10,601.18
Rate for Payer: Clover Medicare Advantage	$10,071.12
Rate for Payer: EmblemHealth Commercial	$31,803.54
Rate for Payer: Humana Medicare Advantage	$10,919.22
Rate for Payer: Oxford Commercial	$9,258.98
Rate for Payer: UnitedHealthcare Commercial	$10,509.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,601.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,237.25
Rate for Payer: Wellcare Medicare Advantage	$10,601.18

COMPLIC REM FB FROM FOOT

Facility

$6,598.80

Service Code	HCPCS 28193
Hospital Charge Code	16000905
Hospital Revenue Code	360
Min. Negotiated Rate	$989.82
Max. Negotiated Rate	$989.82
Rate for Payer: Qualcare PPO/HMO/WC	$989.82

COMPLIC REM FB FROM FOOT

Facility

$6,598.80

Service Code	HCPCS 28193
Hospital Charge Code	16000905
Hospital Revenue Code	360
Min. Negotiated Rate	$857.84
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,979.64
Rate for Payer: Aetna Medicare Advantage	$1,979.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,682.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,682.69
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	$1,682.69
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$857.84
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$989.82
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

COMPLX RE>2.5 CM TONG OR MOUTH

Facility

$3,238.00

Service Code	HCPCS 41252
Hospital Charge Code	5780195
Hospital Revenue Code	450
Min. Negotiated Rate	$196.65
Max. Negotiated Rate	$971.40
Rate for Payer: Aetna Commercial	$971.40
Rate for Payer: Aetna Medicare Advantage	$971.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$825.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$825.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$825.69
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$420.94
Rate for Payer: Qualcare PPO/HMO/WC	$485.70

COMPLX RE>2.5 CM TONG OR MOUTH

Facility

$3,238.00

Service Code	HCPCS 41252
Hospital Charge Code	5780195
Hospital Revenue Code	450
Min. Negotiated Rate	$485.70
Max. Negotiated Rate	$485.70
Rate for Payer: Qualcare PPO/HMO/WC	$485.70

COMPLX REP POST 1/3 TONGUE

Facility

$1,453.00

Service Code	HCPCS 41251
Hospital Charge Code	5780190
Hospital Revenue Code	450
Min. Negotiated Rate	$62.62
Max. Negotiated Rate	$564.04
Rate for Payer: Aetna Commercial	$435.90
Rate for Payer: Aetna Medicare Advantage	$435.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.51
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.89
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

COMPLX REP POST 1/3 TONGUE

Facility

$1,453.00

Service Code	HCPCS 41251
Hospital Charge Code	5780190
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

COMP METABOLIC PANEL***

Facility

$26.00

Service Code	HCPCS 80053
Hospital Charge Code	3004885
Hospital Revenue Code	301
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.21
Rate for Payer: Aetna Medicare Advantage	$10.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.69
Rate for Payer: Cigna Commercial	$10.56
Rate for Payer: Cigna Medicare Advantage	$5.28
Rate for Payer: Clover Medicare Advantage	$10.03
Rate for Payer: EmblemHealth Commercial	$31.68
Rate for Payer: Humana Medicare Advantage	$10.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.19
Rate for Payer: Wellcare Medicare Advantage	$10.56

COMP METABOLIC PANEL***

Facility

$26.00

Service Code	HCPCS 80053
Hospital Charge Code	3004885
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

COMPNT BMT FEM 12 140 162902

Facility

$4,496.00

Hospital Charge Code	270620763
Hospital Revenue Code	278
Min. Negotiated Rate	$674.40
Max. Negotiated Rate	$1,088.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$899.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,088.03
Rate for Payer: Qualcare PPO/HMO/WC	$674.40

COMPNT BMT FEM 12 140 162902

Facility

$4,496.00

Hospital Charge Code	270620763
Hospital Revenue Code	278
Min. Negotiated Rate	$674.40
Max. Negotiated Rate	$2,248.00
Rate for Payer: Aetna Commercial	$1,348.80
Rate for Payer: Aetna Medicare Advantage	$1,348.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,146.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,146.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$899.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,146.48
Rate for Payer: Cigna Commercial	$2,248.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,088.03
Rate for Payer: Qualcare PPO/HMO/WC	$674.40

COMPNT BMT FEM BIMETRIC 162353

Facility

$18,035.00

Hospital Charge Code	270611437
Hospital Revenue Code	278
Min. Negotiated Rate	$2,705.25
Max. Negotiated Rate	$4,364.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,607.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,364.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,705.25

COMPNT BMT FEM BIMETRIC 162353

Facility

$18,035.00

Hospital Charge Code	270611437
Hospital Revenue Code	278
Min. Negotiated Rate	$2,705.25
Max. Negotiated Rate	$9,017.50
Rate for Payer: Aetna Commercial	$5,410.50
Rate for Payer: Aetna Medicare Advantage	$5,410.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,598.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,598.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,607.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,598.93
Rate for Payer: Cigna Commercial	$9,017.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,364.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,705.25

COMPNT BMT FEM HEAD 38 173660

Facility

$4,870.75

Hospital Charge Code	270628145
Hospital Revenue Code	278
Min. Negotiated Rate	$730.61
Max. Negotiated Rate	$1,178.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.72
Rate for Payer: Qualcare PPO/HMO/WC	$730.61

COMPNT BMT FEM HEAD 38 173660

Facility

$4,870.75

Hospital Charge Code	270628145
Hospital Revenue Code	278
Min. Negotiated Rate	$730.61
Max. Negotiated Rate	$2,435.38
Rate for Payer: Aetna Commercial	$1,461.22
Rate for Payer: Aetna Medicare Advantage	$1,461.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,242.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,242.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,242.04
Rate for Payer: Cigna Commercial	$2,435.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.72
Rate for Payer: Qualcare PPO/HMO/WC	$730.61

COMPNT BMT FEM LT 60MM 140071

Facility

$7,916.85

Hospital Charge Code	270609001
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.53
Max. Negotiated Rate	$3,958.43
Rate for Payer: Aetna Commercial	$2,375.05
Rate for Payer: Aetna Medicare Advantage	$2,375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,018.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,018.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,018.80
Rate for Payer: Cigna Commercial	$3,958.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.53

COMPNT BMT FEM LT 60MM 140071

Facility

$7,916.85

Hospital Charge Code	270609001
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.53
Max. Negotiated Rate	$1,915.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,583.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.53

COMPNT BMT FEM LT 60MM 144171

Facility

$13,420.00

Hospital Charge Code	270628234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,013.00
Max. Negotiated Rate	$3,247.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,247.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.00

COMPNT BMT FEM LT 60MM 144171

Facility

$13,420.00

Hospital Charge Code	270628234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,013.00
Max. Negotiated Rate	$6,710.00
Rate for Payer: Aetna Commercial	$4,026.00
Rate for Payer: Aetna Medicare Advantage	$4,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,422.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,422.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,422.10
Rate for Payer: Cigna Commercial	$6,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,247.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.00

COMPNT BMT FEM LT 65MM 145132

Facility

$6,630.45

Hospital Charge Code	270609397
Hospital Revenue Code	278
Min. Negotiated Rate	$994.57
Max. Negotiated Rate	$1,604.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,326.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,604.57
Rate for Payer: Qualcare PPO/HMO/WC	$994.57

COMPNT BMT FEM LT 65MM 145132

Facility

$6,630.45

Hospital Charge Code	270609397
Hospital Revenue Code	278
Min. Negotiated Rate	$994.57
Max. Negotiated Rate	$3,315.22
Rate for Payer: Aetna Commercial	$1,989.13
Rate for Payer: Aetna Medicare Advantage	$1,989.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,690.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,690.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,326.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,690.76
Rate for Payer: Cigna Commercial	$3,315.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,604.57
Rate for Payer: Qualcare PPO/HMO/WC	$994.57

COMPNT BMT FEM LT 75MM 145134

Facility

$6,629.65

Hospital Charge Code	270606321
Hospital Revenue Code	278
Min. Negotiated Rate	$994.45
Max. Negotiated Rate	$3,314.82
Rate for Payer: Aetna Commercial	$1,988.89
Rate for Payer: Aetna Medicare Advantage	$1,988.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,690.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,690.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,325.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,690.56
Rate for Payer: Cigna Commercial	$3,314.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,604.38
Rate for Payer: Qualcare PPO/HMO/WC	$994.45

COMPNT BMT FEM LT 75MM 145134

Facility

$6,629.65

Hospital Charge Code	270606321
Hospital Revenue Code	278
Min. Negotiated Rate	$994.45
Max. Negotiated Rate	$1,604.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,325.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,604.38
Rate for Payer: Qualcare PPO/HMO/WC	$994.45

COMPNT BMT FEM RT 60MM 145111

Facility

$8,154.45

Hospital Charge Code	270609694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.17
Max. Negotiated Rate	$4,077.22
Rate for Payer: Aetna Commercial	$2,446.34
Rate for Payer: Aetna Medicare Advantage	$2,446.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,079.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,079.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,630.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,079.38
Rate for Payer: Cigna Commercial	$4,077.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,973.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,223.17

COMPNT BMT FEM RT 60MM 145111

Facility

$8,154.45

Hospital Charge Code	270609694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.17
Max. Negotiated Rate	$1,973.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,630.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,973.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,223.17

Know your out-of-pocket cost for care.

All Charges