Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER BURN DSG/DEBRID MED W/O ANE

Facility

$847.50

Service Code	HCPCS 16025
Hospital Charge Code	5700542
Hospital Revenue Code	450
Min. Negotiated Rate	$94.17
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$254.25
Rate for Payer: Aetna Medicare Advantage	$254.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.11
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.17
Rate for Payer: Qualcare PPO/HMO/WC	$127.12

ER CARDIOVERSION

Facility

$2,190.00

Service Code	HCPCS 92960
Hospital Charge Code	5700260
Hospital Revenue Code	450
Min. Negotiated Rate	$284.70
Max. Negotiated Rate	$1,573.96
Rate for Payer: Aetna Commercial	$657.00
Rate for Payer: Aetna Medicare Advantage	$657.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.45
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.70
Rate for Payer: Qualcare PPO/HMO/WC	$328.50

ER CARDIOVERSION

Facility

$2,190.00

Service Code	HCPCS 92960
Hospital Charge Code	5700260
Hospital Revenue Code	450
Min. Negotiated Rate	$328.50
Max. Negotiated Rate	$328.50
Rate for Payer: Qualcare PPO/HMO/WC	$328.50

ER CASTING/STRAPPING LEVEL I

Facility

$218.25

Hospital Charge Code	5700026
Hospital Revenue Code	450
Min. Negotiated Rate	$28.37
Max. Negotiated Rate	$109.12
Rate for Payer: Aetna Commercial	$65.47
Rate for Payer: Aetna Medicare Advantage	$65.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.65
Rate for Payer: Cigna Commercial	$109.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.37
Rate for Payer: Qualcare PPO/HMO/WC	$32.74

ER CASTING/STRAPPING LEVEL I

Facility

$218.25

Hospital Charge Code	5700026
Hospital Revenue Code	450
Min. Negotiated Rate	$32.74
Max. Negotiated Rate	$32.74
Rate for Payer: Qualcare PPO/HMO/WC	$32.74

ER CASTING/STRAPPING LEVEL II

Facility

$346.90

Hospital Charge Code	5700028
Hospital Revenue Code	450
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$173.45
Rate for Payer: Aetna Commercial	$104.07
Rate for Payer: Aetna Medicare Advantage	$104.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.46
Rate for Payer: Cigna Commercial	$173.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.10
Rate for Payer: Qualcare PPO/HMO/WC	$52.03

ER CASTING/STRAPPING LEVEL II

Facility

$346.90

Hospital Charge Code	5700028
Hospital Revenue Code	450
Min. Negotiated Rate	$52.03
Max. Negotiated Rate	$52.03
Rate for Payer: Qualcare PPO/HMO/WC	$52.03

ER-CAST/STARPP OTHER-BI

Facility

$305.00

Hospital Charge Code	5790785
Hospital Revenue Code	450
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$45.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

ER-CAST/STARPP OTHER-BI

Facility

$305.00

Hospital Charge Code	5790785
Hospital Revenue Code	450
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$152.50
Rate for Payer: Aetna Commercial	$91.50
Rate for Payer: Aetna Medicare Advantage	$91.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.78
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.65
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

ER CATH ASPIRATION NASOTRACH

Facility

$128.00

Service Code	HCPCS 31720
Hospital Charge Code	5700406
Hospital Revenue Code	450
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

ER CATH ASPIRATION NASOTRACH

Facility

$128.00

Service Code	HCPCS 31720
Hospital Charge Code	5700406
Hospital Revenue Code	450
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$521.47
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

ER-CAUTERY OF CERVIX

Facility

$5,763.00

Service Code	HCPCS 57510
Hospital Charge Code	5790200
Hospital Revenue Code	450
Min. Negotiated Rate	$25.76
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$1,728.90
Rate for Payer: Aetna Medicare Advantage	$1,728.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,469.57
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.19
Rate for Payer: Qualcare PPO/HMO/WC	$864.45

ER-CAUTERY OF CERVIX

Facility

$5,763.00

Service Code	HCPCS 57510
Hospital Charge Code	5790200
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$864.45
Rate for Payer: Qualcare PPO/HMO/WC	$864.45

ER CENTRAL LINE INSERT <5YRS

Facility

$6,107.50

Service Code	HCPCS 36555
Hospital Charge Code	5700779
Hospital Revenue Code	450
Min. Negotiated Rate	$916.12
Max. Negotiated Rate	$916.12
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

ER CENTRAL LINE INSERT <5YRS

Facility

$6,107.50

Service Code	HCPCS 36555
Hospital Charge Code	5700779
Hospital Revenue Code	450
Min. Negotiated Rate	$197.80
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,832.25
Rate for Payer: Aetna Medicare Advantage	$1,832.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,557.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,557.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,557.41
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.98
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

ER CENTRAL LINE INSERT>5YRS

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	5700780
Hospital Revenue Code	450
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,832.25
Rate for Payer: Aetna Medicare Advantage	$1,832.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,557.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,557.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,557.41
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.98
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

ER CENTRAL LINE INSERT>5YRS

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	5700780
Hospital Revenue Code	450
Min. Negotiated Rate	$916.12
Max. Negotiated Rate	$916.12
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

ER CHANGE G TUBE

Facility

$776.45

Service Code	HCPCS 43760
Hospital Charge Code	5700293
Hospital Revenue Code	450
Min. Negotiated Rate	$100.94
Max. Negotiated Rate	$781.67
Rate for Payer: Aetna Better Health Medicaid	$766.34
Rate for Payer: Aetna Commercial	$232.94
Rate for Payer: Aetna Medicare Advantage	$232.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.99
Rate for Payer: Cigna Commercial	$388.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.94
Rate for Payer: Qualcare PPO/HMO/WC	$116.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$781.67

ER CHANGE G TUBE

Facility

$776.45

Service Code	HCPCS 43760
Hospital Charge Code	5700293
Hospital Revenue Code	450
Min. Negotiated Rate	$116.47
Max. Negotiated Rate	$116.47
Rate for Payer: Qualcare PPO/HMO/WC	$116.47

ER-CHEMCAL CAUTERY TISSUE

Facility

$990.50

Service Code	HCPCS 17250
Hospital Charge Code	5790045
Hospital Revenue Code	450
Min. Negotiated Rate	$148.57
Max. Negotiated Rate	$148.57
Rate for Payer: Qualcare PPO/HMO/WC	$148.57

ER-CHEMCAL CAUTERY TISSUE

Facility

$990.50

Service Code	HCPCS 17250
Hospital Charge Code	5790045
Hospital Revenue Code	450
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$297.15
Rate for Payer: Aetna Medicare Advantage	$297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.58
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.76
Rate for Payer: Qualcare PPO/HMO/WC	$148.57

ER CHEMO IM/SQ NON HORM

Facility

$462.00

Service Code	HCPCS 96401
Hospital Charge Code	5792276
Hospital Revenue Code	331
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.30

ER CHEMO IM/SQ NON HORM

Facility

$462.00

Service Code	HCPCS 96401
Hospital Charge Code	5792276
Hospital Revenue Code	331
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$138.60
Rate for Payer: Aetna Medicare Advantage	$138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.81
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.06
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.30
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

ER-CHG CYSTO TUBE-SIMPLE

Facility

$576.00

Service Code	HCPCS 51705
Hospital Charge Code	5790170
Hospital Revenue Code	450
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$86.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

ER-CHG CYSTO TUBE-SIMPLE

Facility

$576.00

Service Code	HCPCS 51705
Hospital Charge Code	5790170
Hospital Revenue Code	450
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$594.98
Rate for Payer: Aetna Commercial	$172.80
Rate for Payer: Aetna Medicare Advantage	$172.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.88
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.88
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

Know your out-of-pocket cost for care.

All Charges