Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER COMPREHENSIVE - PP V

Facility

$6,582.85

Service Code	HCPCS 9928525
Hospital Charge Code	5700240
Hospital Revenue Code	450
Min. Negotiated Rate	$987.43
Max. Negotiated Rate	$987.43
Rate for Payer: Qualcare PPO/HMO/WC	$987.43

ER COMPREHENSIVE - PP V

Facility

$6,582.85

Service Code	HCPCS 9928525
Hospital Charge Code	5700240
Hospital Revenue Code	450
Min. Negotiated Rate	$855.77
Max. Negotiated Rate	$3,291.43
Rate for Payer: Aetna Commercial	$1,974.86
Rate for Payer: Aetna Medicare Advantage	$1,974.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,678.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,678.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,678.63
Rate for Payer: Cigna Commercial	$3,291.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$855.77
Rate for Payer: Qualcare PPO/HMO/WC	$987.43

ER COMPREHENSIVE - PP V W/O MF

Facility

$6,582.85

Service Code	HCPCS 99285
Hospital Charge Code	5700239
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,481.00
Rate for Payer: Aetna Commercial	$1,974.86
Rate for Payer: Aetna Medicare Advantage	$1,974.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,678.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,678.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,678.63
Rate for Payer: Cigna Commercial	$1,418.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.00
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$987.43
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER COMPREHENSIVE - PP V W/O MF

Facility

$6,582.85

Service Code	HCPCS 99285
Hospital Charge Code	5700239
Hospital Revenue Code	450
Min. Negotiated Rate	$987.43
Max. Negotiated Rate	$987.43
Rate for Payer: Qualcare PPO/HMO/WC	$987.43

ER COMPREHENSIVE - V

Facility

$21,839.90

Service Code	HCPCS 99285
Hospital Charge Code	5700109
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,551.97
Rate for Payer: Aetna Commercial	$6,551.97
Rate for Payer: Aetna Medicare Advantage	$6,551.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,569.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,569.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,569.17
Rate for Payer: Cigna Commercial	$1,418.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.00
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,275.99
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER COMPREHENSIVE - V

Facility

$21,839.90

Service Code	HCPCS 99285
Hospital Charge Code	5700109
Hospital Revenue Code	450
Min. Negotiated Rate	$3,275.99
Max. Negotiated Rate	$3,275.99
Rate for Payer: Qualcare PPO/HMO/WC	$3,275.99

ER COMPREHENSIVE - V W/O MF

Facility

$21,654.71

Service Code	HCPCS 99285
Hospital Charge Code	5700108
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,496.41
Rate for Payer: Aetna Commercial	$6,496.41
Rate for Payer: Aetna Medicare Advantage	$6,496.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,521.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,521.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,521.95
Rate for Payer: Cigna Commercial	$1,418.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,064.00
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,248.21
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER COMPREHENSIVE - V W/O MF

Facility

$21,654.71

Service Code	HCPCS 99285
Hospital Charge Code	5700108
Hospital Revenue Code	450
Min. Negotiated Rate	$3,248.21
Max. Negotiated Rate	$3,248.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,248.21

ER COMP REP FACE 2.6-7.5 CM

Facility

$2,341.51

Service Code	HCPCS 13152
Hospital Charge Code	5700499
Hospital Revenue Code	450
Min. Negotiated Rate	$351.23
Max. Negotiated Rate	$351.23
Rate for Payer: Qualcare PPO/HMO/WC	$351.23

ER COMP REP FACE 2.6-7.5 CM

Facility

$2,341.51

Service Code	HCPCS 13152
Hospital Charge Code	5700499
Hospital Revenue Code	450
Min. Negotiated Rate	$245.87
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$702.45
Rate for Payer: Aetna Medicare Advantage	$702.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$597.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$597.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$597.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.40
Rate for Payer: Qualcare PPO/HMO/WC	$351.23

ER COMP REP FACE >7.6 EA ADDL

Facility

$1,723.35

Service Code	HCPCS 13153
Hospital Charge Code	5700720
Hospital Revenue Code	450
Min. Negotiated Rate	$75.03
Max. Negotiated Rate	$517.00
Rate for Payer: Aetna Commercial	$517.00
Rate for Payer: Aetna Medicare Advantage	$517.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.45
Rate for Payer: Cigna Commercial	$123.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.04
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER COMP REP FACE >7.6 EA ADDL

Facility

$1,723.35

Service Code	HCPCS 13153
Hospital Charge Code	5700720
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER COM REP FACE 1.1-2.5

Facility

$1,456.25

Service Code	HCPCS 13151
Hospital Charge Code	5700540
Hospital Revenue Code	450
Min. Negotiated Rate	$218.44
Max. Negotiated Rate	$218.44
Rate for Payer: Qualcare PPO/HMO/WC	$218.44

ER COM REP FACE 1.1-2.5

Facility

$1,456.25

Service Code	HCPCS 13151
Hospital Charge Code	5700540
Hospital Revenue Code	450
Min. Negotiated Rate	$184.12
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Better Health Medicaid	$1,607.24
Rate for Payer: Aetna Commercial	$436.88
Rate for Payer: Aetna Medicare Advantage	$436.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$371.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$371.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$371.34
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.31
Rate for Payer: Qualcare PPO/HMO/WC	$218.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,639.38

ER COM REP FACE HAND FEET 2.5

Facility

$1,443.75

Service Code	HCPCS 13132
Hospital Charge Code	5700539
Hospital Revenue Code	450
Min. Negotiated Rate	$187.69
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$433.12
Rate for Payer: Aetna Medicare Advantage	$433.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$234.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.16
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.69
Rate for Payer: Qualcare PPO/HMO/WC	$216.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER COM REP FACE HAND FEET 2.5

Facility

$1,443.75

Service Code	HCPCS 13132
Hospital Charge Code	5700539
Hospital Revenue Code	450
Min. Negotiated Rate	$216.56
Max. Negotiated Rate	$216.56
Rate for Payer: Qualcare PPO/HMO/WC	$216.56

ER COM REP FACE UP TO 1.00

Facility

$2,427.80

Hospital Charge Code	5700719
Hospital Revenue Code	450
Min. Negotiated Rate	$315.61
Max. Negotiated Rate	$1,213.90
Rate for Payer: Aetna Commercial	$728.34
Rate for Payer: Aetna Medicare Advantage	$728.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$619.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$619.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$619.09
Rate for Payer: Cigna Commercial	$1,213.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.61
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

ER COM REP FACE UP TO 1.00

Facility

$2,427.80

Hospital Charge Code	5700719
Hospital Revenue Code	450
Min. Negotiated Rate	$364.17
Max. Negotiated Rate	$364.17
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

ER COM REP FAC HAD FET EA ADD5

Facility

$1,723.35

Service Code	HCPCS 13133
Hospital Charge Code	5700718
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER COM REP FAC HAD FET EA ADD5

Facility

$1,723.35

Service Code	HCPCS 13133
Hospital Charge Code	5700718
Hospital Revenue Code	450
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$517.00
Rate for Payer: Aetna Commercial	$517.00
Rate for Payer: Aetna Medicare Advantage	$517.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.45
Rate for Payer: Cigna Commercial	$110.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.04
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER COM REP TRUNK 1.1-2.5CM

Facility

$2,427.80

Service Code	HCPCS 13100
Hospital Charge Code	5700715
Hospital Revenue Code	450
Min. Negotiated Rate	$82.11
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$728.34
Rate for Payer: Aetna Medicare Advantage	$728.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$619.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$619.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$619.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.61
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

ER COM REP TRUNK 1.1-2.5CM

Facility

$2,427.80

Service Code	HCPCS 13100
Hospital Charge Code	5700715
Hospital Revenue Code	450
Min. Negotiated Rate	$364.17
Max. Negotiated Rate	$364.17
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

ER COM REP TRUNK 2.6CM-7.5CM

Facility

$2,370.40

Service Code	HCPCS 13101
Hospital Charge Code	5700284
Hospital Revenue Code	450
Min. Negotiated Rate	$157.39
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$711.12
Rate for Payer: Aetna Medicare Advantage	$711.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$604.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$604.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$604.45
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.15
Rate for Payer: Qualcare PPO/HMO/WC	$355.56

ER COM REP TRUNK 2.6CM-7.5CM

Facility

$2,370.40

Service Code	HCPCS 13101
Hospital Charge Code	5700284
Hospital Revenue Code	450
Min. Negotiated Rate	$355.56
Max. Negotiated Rate	$355.56
Rate for Payer: Qualcare PPO/HMO/WC	$355.56

ER COM REP TRUNK >7.6EA ADDL 5

Facility

$2,427.80

Service Code	HCPCS 13102
Hospital Charge Code	5700716
Hospital Revenue Code	450
Min. Negotiated Rate	$364.17
Max. Negotiated Rate	$364.17
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

Know your out-of-pocket cost for care.

All Charges