Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER CLSD TX SCAPULA W/O MANIP

Facility

$906.60

Service Code	HCPCS 23570
Hospital Charge Code	5700735
Hospital Revenue Code	450
Min. Negotiated Rate	$135.99
Max. Negotiated Rate	$135.99
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX SCAPULA W/O MANIP

Facility

$906.60

Service Code	HCPCS 23570
Hospital Charge Code	5700735
Hospital Revenue Code	450
Min. Negotiated Rate	$99.02
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$271.98
Rate for Payer: Aetna Medicare Advantage	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.18
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.86
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX SUP/TRANS HUM FX WO

Facility

$563.75

Service Code	HCPCS 24530
Hospital Charge Code	5700560
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CLSD TX SUP/TRANS HUM FX WO

Facility

$563.75

Service Code	HCPCS 24530
Hospital Charge Code	5700560
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CLSD TX TALUS W/O MANIP

Facility

$906.60

Service Code	HCPCS 28430
Hospital Charge Code	5700769
Hospital Revenue Code	450
Min. Negotiated Rate	$112.85
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$271.98
Rate for Payer: Aetna Medicare Advantage	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.18
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.86
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX TALUS W/O MANIP

Facility

$906.60

Service Code	HCPCS 28430
Hospital Charge Code	5700769
Hospital Revenue Code	450
Min. Negotiated Rate	$135.99
Max. Negotiated Rate	$135.99
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX TARSAL BONE W/O MAN

Facility

$906.60

Service Code	HCPCS 28450
Hospital Charge Code	5700770
Hospital Revenue Code	450
Min. Negotiated Rate	$99.02
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$271.98
Rate for Payer: Aetna Medicare Advantage	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.18
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.86
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX TARSAL BONE W/O MAN

Facility

$906.60

Service Code	HCPCS 28450
Hospital Charge Code	5700770
Hospital Revenue Code	450
Min. Negotiated Rate	$135.99
Max. Negotiated Rate	$135.99
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX TIBIAL SHAFT W/ MAN

Facility

$10,062.15

Service Code	HCPCS 27752
Hospital Charge Code	5700764
Hospital Revenue Code	450
Min. Negotiated Rate	$1,509.32
Max. Negotiated Rate	$1,509.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,509.32

ER CLSD TX TIBIAL SHAFT W/ MAN

Facility

$10,062.15

Service Code	HCPCS 27752
Hospital Charge Code	5700764
Hospital Revenue Code	450
Min. Negotiated Rate	$259.89
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$3,018.64
Rate for Payer: Aetna Medicare Advantage	$3,018.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,565.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,565.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,565.85
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,308.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,509.32

ER CLSD TX TROCHANTER W/O MANI

Facility

$2,622.50

Service Code	HCPCS 27238
Hospital Charge Code	5700756
Hospital Revenue Code	450
Min. Negotiated Rate	$393.38
Max. Negotiated Rate	$393.38
Rate for Payer: Qualcare PPO/HMO/WC	$393.38

ER CLSD TX TROCHANTER W/O MANI

Facility

$2,622.50

Service Code	HCPCS 27238
Hospital Charge Code	5700756
Hospital Revenue Code	450
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$786.75
Rate for Payer: Aetna Medicare Advantage	$786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$668.74
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.93
Rate for Payer: Qualcare PPO/HMO/WC	$393.38

ER CLSD TX ULNAR SHAFT W/ MANI

Facility

$906.60

Service Code	HCPCS 25535
Hospital Charge Code	5700748
Hospital Revenue Code	450
Min. Negotiated Rate	$117.86
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$271.98
Rate for Payer: Aetna Medicare Advantage	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.18
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.86
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CLSD TX ULNAR SHAFT W/ MANI

Facility

$906.60

Service Code	HCPCS 25535
Hospital Charge Code	5700748
Hospital Revenue Code	450
Min. Negotiated Rate	$135.99
Max. Negotiated Rate	$135.99
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER CL TX BIMAL ANK FX W/MANI

Facility

$563.75

Service Code	HCPCS 27808
Hospital Charge Code	5700603
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX BIMAL ANK FX W/MANI

Facility

$563.75

Service Code	HCPCS 27808
Hospital Charge Code	5700603
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$723.02
Rate for Payer: Aetna Better Health Medicaid	$708.84
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02

ER CL TX BIMAL ANKLE FX W/MANI

Facility

$563.75

Service Code	HCPCS 27810
Hospital Charge Code	5700604
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX BIMAL ANKLE FX W/MANI

Facility

$563.75

Service Code	HCPCS 27810
Hospital Charge Code	5700604
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX CARPAL FX W/MAN EACH

Facility

$563.75

Service Code	HCPCS 25635
Hospital Charge Code	5700572
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX CARPAL FX W/MAN EACH

Facility

$563.75

Service Code	HCPCS 25635
Hospital Charge Code	5700572
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX CARPAL SCAP FX W/O AN

Facility

$563.75

Service Code	HCPCS 25622
Hospital Charge Code	5700570
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX CARPAL SCAP FX W/O AN

Facility

$563.75

Service Code	HCPCS 25622
Hospital Charge Code	5700570
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX COCCYGEAL FX

Facility

$563.75

Service Code	HCPCS 27200
Hospital Charge Code	5700586
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX COCCYGEAL FX

Facility

$563.75

Service Code	HCPCS 27200
Hospital Charge Code	5700586
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX DIS FIB FX W/MANI

Facility

$563.75

Service Code	HCPCS 27788
Hospital Charge Code	5700602
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$587.42
Rate for Payer: Qualcare PPO/HMO/WC	$84.56
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29

Know your out-of-pocket cost for care.

All Charges