Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER CL TX DIS FIB FX W/O MANI

Facility

$563.75

Service Code	HCPCS 27786
Hospital Charge Code	5700601
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/O MANI

Facility

$563.75

Service Code	HCPCS 27786
Hospital Charge Code	5700601
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	$150.95
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 DIS FING JT SNG WO AN

Facility

$563.75

Service Code	HCPCS 26770
Hospital Charge Code	5700585
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 FING JT SNG WO AN

Facility

$563.75

Service Code	HCPCS 26770
Hospital Charge Code	5700585
Hospital Revenue Code	450
Min. Negotiated Rate	$48.30
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	$48.30
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 DISL ANKLE W/ANES

Facility

$7,070.00

Service Code	HCPCS 27842
Hospital Charge Code	5700607
Hospital Revenue Code	450
Min. Negotiated Rate	$1,060.50
Max. Negotiated Rate	$1,060.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.50

ER CL TX DISL ANKLE W/ANES

Facility

$7,070.00

Service Code	HCPCS 27842
Hospital Charge Code	5700607
Hospital Revenue Code	450
Min. Negotiated Rate	$147.31
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,121.00
Rate for Payer: Aetna Medicare Advantage	$2,121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,802.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,802.85
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	$1,802.85
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.50

ER CL TX DIS PHAL FX W/MAN EAC

Facility

$563.75

Service Code	HCPCS 26755
Hospital Charge Code	5700584
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	$108.16
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 DIS PHAL FX W/MAN EAC

Facility

$563.75

Service Code	HCPCS 26755
Hospital Charge Code	5700584
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 DIST RADIAL FX W ANES

Facility

$563.75

Service Code	HCPCS 25605
Hospital Charge Code	5700569
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	$186.30
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 DIST RADIAL FX W ANES

Facility

$563.75

Service Code	HCPCS 25605
Hospital Charge Code	5700569
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 DIST RADIAL FX W/O AN

Facility

$563.75

Service Code	HCPCS 25600
Hospital Charge Code	5700568
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	$138.87
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 DIST RADIAL FX W/O AN

Facility

$563.75

Service Code	HCPCS 25600
Hospital Charge Code	5700568
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 DST PHAL FX W/MAN EAC

Facility

$6,381.00

Service Code	HCPCS 26775
Hospital Charge Code	5700828
Hospital Revenue Code	450
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$1,914.30
Rate for Payer: Aetna Commercial	$1,914.30
Rate for Payer: Aetna Medicare Advantage	$1,914.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,627.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,627.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,627.15
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.53
Rate for Payer: Qualcare PPO/HMO/WC	$957.15

ER CL TX DST PHAL FX W/MAN EAC

Facility

$6,381.00

Service Code	HCPCS 26775
Hospital Charge Code	5700828
Hospital Revenue Code	450
Min. Negotiated Rate	$957.15
Max. Negotiated Rate	$957.15
Rate for Payer: Qualcare PPO/HMO/WC	$957.15

ER CL TX FEM FX D/M/L W/MAN

Facility

$563.75

Service Code	HCPCS 27510
Hospital Charge Code	5700591
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 FEM FX D/M/L W/MAN

Facility

$563.75

Service Code	HCPCS 27510
Hospital Charge Code	5700591
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	$292.21
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 FEM FX D/M/L W/O MANI

Facility

$563.75

Service Code	HCPCS 27508
Hospital Charge Code	5700590
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	$169.05
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 FEM FX D/M/L W/O MANI

Facility

$563.75

Service Code	HCPCS 27508
Hospital Charge Code	5700590
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 GR TOE FX W/O MAN

Facility

$563.75

Service Code	HCPCS 28490
Hospital Charge Code	5700609
Hospital Revenue Code	450
Min. Negotiated Rate	$43.47
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	$43.47
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 GR TOE FX W/O MAN

Facility

$563.75

Service Code	HCPCS 28490
Hospital Charge Code	5700609
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 HIP DISL TRAUMA W/O A

Facility

$563.75

Service Code	HCPCS 27250
Hospital Charge Code	5700587
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	$232.00
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 HIP DISL TRAUMA W/O A

Facility

$563.75

Service Code	HCPCS 27250
Hospital Charge Code	5700587
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 INTPHAL JNT DIS W/O A

Facility

$563.75

Service Code	HCPCS 28660
Hospital Charge Code	5700612
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 INTPHAL JNT DIS W/O A

Facility

$563.75

Service Code	HCPCS 28660
Hospital Charge Code	5700612
Hospital Revenue Code	450
Min. Negotiated Rate	$38.64
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	$38.64
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

Know your out-of-pocket cost for care.

All Charges