Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$39.10
Max. Negotiated Rate	$728.34
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	$39.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$619.09
Rate for Payer: Cigna Commercial	$64.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.61
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

ER CONTROL NOSEBLD ANT COMPLEX

Facility

$491.25

Service Code	HCPCS 30903
Hospital Charge Code	5700432
Hospital Revenue Code	450
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$147.38
Rate for Payer: Aetna Medicare Advantage	$147.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.27
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	$125.27
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.86
Rate for Payer: Qualcare PPO/HMO/WC	$73.69

ER CONTROL NOSEBLD ANT COMPLEX

Facility

$491.25

Service Code	HCPCS 30903
Hospital Charge Code	5700432
Hospital Revenue Code	450
Min. Negotiated Rate	$73.69
Max. Negotiated Rate	$73.69
Rate for Payer: Qualcare PPO/HMO/WC	$73.69

ER CONTROL NOSEBLD ANT SIMPLE

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	5700430
Hospital Revenue Code	450
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$132.74
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
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	$112.82
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.52
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

ER CONTROL NOSEBLD ANT SIMPLE

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	5700430
Hospital Revenue Code	450
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

ER CONTROL NOSEBLD POST INITAL

Facility

$504.60

Service Code	HCPCS 30905
Hospital Charge Code	5700435
Hospital Revenue Code	450
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$75.69
Rate for Payer: Qualcare PPO/HMO/WC	$75.69

ER CONTROL NOSEBLD POST INITAL

Facility

$504.60

Service Code	HCPCS 30905
Hospital Charge Code	5700435
Hospital Revenue Code	450
Min. Negotiated Rate	$59.57
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$151.38
Rate for Payer: Aetna Medicare Advantage	$151.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.67
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.60
Rate for Payer: Qualcare PPO/HMO/WC	$75.69

ER CONTROL NOSEBLD POST SUBSEQ

Facility

$504.60

Service Code	HCPCS 30906
Hospital Charge Code	5700437
Hospital Revenue Code	450
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$75.69
Rate for Payer: Qualcare PPO/HMO/WC	$75.69

ER CONTROL NOSEBLD POST SUBSEQ

Facility

$504.60

Service Code	HCPCS 30906
Hospital Charge Code	5700437
Hospital Revenue Code	450
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$564.04
Rate for Payer: Aetna Commercial	$151.38
Rate for Payer: Aetna Medicare Advantage	$151.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.67
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	$128.67
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.60
Rate for Payer: Qualcare PPO/HMO/WC	$75.69

ERCP***

Facility

$531.00

Hospital Charge Code	2300200
Hospital Revenue Code	759
Min. Negotiated Rate	$69.03
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna Commercial	$159.30
Rate for Payer: Aetna Medicare Advantage	$159.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.41
Rate for Payer: Cigna Commercial	$265.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.03
Rate for Payer: Qualcare PPO/HMO/WC	$79.65

ERCP***

Facility

$531.00

Hospital Charge Code	2300200
Hospital Revenue Code	759
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$79.65
Rate for Payer: Qualcare PPO/HMO/WC	$79.65

ERCP FOR SPHINCT/PAPILLOTOMY

Facility

$9,500.80

Service Code	HCPCS 43262
Hospital Charge Code	16000823
Hospital Revenue Code	360
Min. Negotiated Rate	$1,235.10
Max. Negotiated Rate	$9,181.40
Rate for Payer: Aetna Commercial	$2,850.24
Rate for Payer: Aetna Medicare Advantage	$2,850.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.70
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	$2,422.70
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.12
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ERCP FOR SPHINCT/PAPILLOTOMY

Facility

$9,500.80

Service Code	HCPCS 43262
Hospital Charge Code	16000823
Hospital Revenue Code	360
Min. Negotiated Rate	$1,425.12
Max. Negotiated Rate	$1,425.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.12

ER CPLX REP LIP - 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40652
Hospital Charge Code	5700786
Hospital Revenue Code	450
Min. Negotiated Rate	$262.20
Max. Negotiated Rate	$1,284.36
Rate for Payer: Aetna Commercial	$1,250.31
Rate for Payer: Aetna Medicare Advantage	$1,250.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.76
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.80
Rate for Payer: Qualcare PPO/HMO/WC	$625.15

ER CPLX REP LIP - 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40652
Hospital Charge Code	5700786
Hospital Revenue Code	450
Min. Negotiated Rate	$625.15
Max. Negotiated Rate	$625.15
Rate for Payer: Qualcare PPO/HMO/WC	$625.15

ER CPLX REP LIP > 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40654
Hospital Charge Code	5700787
Hospital Revenue Code	450
Min. Negotiated Rate	$317.40
Max. Negotiated Rate	$3,694.94
Rate for Payer: Aetna Commercial	$1,250.31
Rate for Payer: Aetna Medicare Advantage	$1,250.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.76
Rate for Payer: Cigna Commercial	$3,694.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.80
Rate for Payer: Qualcare PPO/HMO/WC	$625.15

ER CPLX REP LIP > 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40654
Hospital Charge Code	5700787
Hospital Revenue Code	450
Min. Negotiated Rate	$625.15
Max. Negotiated Rate	$625.15
Rate for Payer: Qualcare PPO/HMO/WC	$625.15

ER CPR

Facility

$1,120.00

Service Code	HCPCS 92950
Hospital Charge Code	5700255
Hospital Revenue Code	480
Min. Negotiated Rate	$59.57
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$336.00
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.60
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

ER CPR

Facility

$1,120.00

Service Code	HCPCS 92950
Hospital Charge Code	5700255
Hospital Revenue Code	480
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

ERCP REMOVE DUCT CALCULI

Facility

$22,967.20

Service Code	HCPCS 43264
Hospital Charge Code	16000965
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$9,181.40
Rate for Payer: Aetna Commercial	$6,890.16
Rate for Payer: Aetna Medicare Advantage	$6,890.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,856.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,856.64
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	$5,856.64
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,985.74
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,445.08
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ERCP REMOVE DUCT CALCULI

Facility

$22,967.20

Service Code	HCPCS 43264
Hospital Charge Code	16000965
Hospital Revenue Code	360
Min. Negotiated Rate	$3,445.08
Max. Negotiated Rate	$3,445.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,445.08

ERCP W/BIOPSY****

Facility

$1,289.00

Hospital Charge Code	2300014
Hospital Revenue Code	759
Min. Negotiated Rate	$167.57
Max. Negotiated Rate	$644.50
Rate for Payer: Aetna Commercial	$386.70
Rate for Payer: Aetna Medicare Advantage	$386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.69
Rate for Payer: Cigna Commercial	$644.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.57
Rate for Payer: Qualcare PPO/HMO/WC	$193.35

ERCP W/BIOPSY****

Facility

$1,289.00

Hospital Charge Code	2300014
Hospital Revenue Code	759
Min. Negotiated Rate	$193.35
Max. Negotiated Rate	$193.35
Rate for Payer: Qualcare PPO/HMO/WC	$193.35

ERCP W/DILATION****

Facility

$1,289.00

Hospital Charge Code	2300015
Hospital Revenue Code	759
Min. Negotiated Rate	$193.35
Max. Negotiated Rate	$193.35
Rate for Payer: Qualcare PPO/HMO/WC	$193.35

ERCP W/DILATION****

Facility

$1,289.00

Hospital Charge Code	2300015
Hospital Revenue Code	759
Min. Negotiated Rate	$167.57
Max. Negotiated Rate	$644.50
Rate for Payer: Aetna Commercial	$386.70
Rate for Payer: Aetna Medicare Advantage	$386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.69
Rate for Payer: Cigna Commercial	$644.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.57
Rate for Payer: Qualcare PPO/HMO/WC	$193.35

Know your out-of-pocket cost for care.

All Charges