Heights University Hospital

All Charges

Charge

Type

Setting

Price

ERCP W/REM FB/CHANGE OF TUBE**

Facility

$1,289.00

Hospital Charge Code	2300016
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/REM FB/CHANGE OF TUBE**

Facility

$1,289.00

Hospital Charge Code	2300016
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/REMOVAL OF STONE***

Facility

$218.00

Service Code	HCPCS 53265
Hospital Charge Code	2300879
Hospital Revenue Code	361
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

ERCP W/REMOVAL OF STONE***

Facility

$218.00

Service Code	HCPCS 53265
Hospital Charge Code	2300879
Hospital Revenue Code	361
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$65.40
Rate for Payer: Aetna Medicare Advantage	$65.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.59
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	$55.59
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ERCP W/SPECIMEN COLLECTION

Facility

$10,176.05

Service Code	HCPCS 43260
Hospital Charge Code	1600000613
Hospital Revenue Code	360
Min. Negotiated Rate	$1,526.41
Max. Negotiated Rate	$1,526.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,526.41

ERCP W/SPECIMEN COLLECTION

Facility

$10,176.05

Service Code	HCPCS 43260
Hospital Charge Code	1600000613
Hospital Revenue Code	360
Min. Negotiated Rate	$1,322.89
Max. Negotiated Rate	$9,181.40
Rate for Payer: Aetna Commercial	$3,052.82
Rate for Payer: Aetna Medicare Advantage	$3,052.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,594.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,594.89
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	$2,594.89
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,322.89
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,526.41
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ER CRITICAL CARE 1ST HOUR

Facility

$10,659.26

Service Code	HCPCS 99291
Hospital Charge Code	5700030
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$3,197.78
Rate for Payer: Aetna Commercial	$3,197.78
Rate for Payer: Aetna Medicare Advantage	$3,197.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,718.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,718.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,718.11
Rate for Payer: Cigna Commercial	$1,967.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.70
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.89
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER CRITICAL CARE 1ST HOUR

Facility

$10,659.26

Service Code	HCPCS 99291
Hospital Charge Code	5700030
Hospital Revenue Code	450
Min. Negotiated Rate	$1,598.89
Max. Negotiated Rate	$1,598.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.89

ER CRITICAL CARE 1ST HR WO MF

Facility

$17,139.05

Service Code	HCPCS 99291
Hospital Charge Code	5700029
Hospital Revenue Code	450
Min. Negotiated Rate	$2,570.86
Max. Negotiated Rate	$2,570.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.86

ER CRITICAL CARE 1ST HR WO MF

Facility

$17,139.05

Service Code	HCPCS 99291
Hospital Charge Code	5700029
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,141.72
Rate for Payer: Aetna Commercial	$5,141.72
Rate for Payer: Aetna Medicare Advantage	$5,141.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,370.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,370.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,370.46
Rate for Payer: Cigna Commercial	$1,967.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,228.08
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.86
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER CRITICAL CARE ADDL 30 MINS

Facility

$837.50

Service Code	HCPCS 99292
Hospital Charge Code	5700031
Hospital Revenue Code	450
Min. Negotiated Rate	$108.24
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$251.25
Rate for Payer: Aetna Medicare Advantage	$251.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.56
Rate for Payer: Cigna Commercial	$108.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.88
Rate for Payer: Qualcare PPO/HMO/WC	$125.62
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER CRITICAL CARE ADDL 30 MINS

Facility

$837.50

Service Code	HCPCS 99292
Hospital Charge Code	5700031
Hospital Revenue Code	450
Min. Negotiated Rate	$125.62
Max. Negotiated Rate	$125.62
Rate for Payer: Qualcare PPO/HMO/WC	$125.62

ER DEBRID ECZEMA INFECTED 10%

Facility

$843.05

Service Code	HCPCS 11000
Hospital Charge Code	5700701
Hospital Revenue Code	450
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$1,639.38
Rate for Payer: Aetna Better Health Medicaid	$1,607.24
Rate for Payer: Aetna Commercial	$252.91
Rate for Payer: Aetna Medicare Advantage	$252.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.98
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.60
Rate for Payer: Qualcare PPO/HMO/WC	$126.46
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,639.38

ER DEBRID ECZEMA INFECTED 10%

Facility

$843.05

Service Code	HCPCS 11000
Hospital Charge Code	5700701
Hospital Revenue Code	450
Min. Negotiated Rate	$126.46
Max. Negotiated Rate	$126.46
Rate for Payer: Qualcare PPO/HMO/WC	$126.46

ER DEBRID ECZEMA INFECTED ADD

Facility

$480.70

Service Code	HCPCS 11001
Hospital Charge Code	5700702
Hospital Revenue Code	450
Min. Negotiated Rate	$13.16
Max. Negotiated Rate	$144.21
Rate for Payer: Aetna Commercial	$144.21
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.58
Rate for Payer: Cigna Commercial	$13.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.49
Rate for Payer: Qualcare PPO/HMO/WC	$72.11

ER DEBRID ECZEMA INFECTED ADD

Facility

$480.70

Service Code	HCPCS 11001
Hospital Charge Code	5700702
Hospital Revenue Code	450
Min. Negotiated Rate	$72.11
Max. Negotiated Rate	$72.11
Rate for Payer: Qualcare PPO/HMO/WC	$72.11

ER DEBRIDE DRESS BURN SMALL

Facility

$354.45

Service Code	HCPCS 16020
Hospital Charge Code	5700410
Hospital Revenue Code	450
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$53.17

ER DEBRIDE DRESS BURN SMALL

Facility

$354.45

Service Code	HCPCS 16020
Hospital Charge Code	5700410
Hospital Revenue Code	450
Min. Negotiated Rate	$46.08
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$106.33
Rate for Payer: Aetna Medicare Advantage	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.38
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.08
Rate for Payer: Qualcare PPO/HMO/WC	$53.17

ER DEBRIDEMENT NAIL 1-5

Facility

$327.35

Service Code	HCPCS 11720
Hospital Charge Code	5700509
Hospital Revenue Code	450
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$49.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.10

ER DEBRIDEMENT NAIL 1-5

Facility

$327.35

Service Code	HCPCS 11720
Hospital Charge Code	5700509
Hospital Revenue Code	450
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$98.20
Rate for Payer: Aetna Medicare Advantage	$98.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.47
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.56
Rate for Payer: Qualcare PPO/HMO/WC	$49.10

ER DEBRIDEMENT NAILS 6 OR MORE

Facility

$480.70

Service Code	HCPCS 11721
Hospital Charge Code	5700705
Hospital Revenue Code	450
Min. Negotiated Rate	$72.11
Max. Negotiated Rate	$72.11
Rate for Payer: Qualcare PPO/HMO/WC	$72.11

ER DEBRIDEMENT NAILS 6 OR MORE

Facility

$480.70

Service Code	HCPCS 11721
Hospital Charge Code	5700705
Hospital Revenue Code	450
Min. Negotiated Rate	$27.24
Max. Negotiated Rate	$197.37
Rate for Payer: Aetna Better Health Medicaid	$193.50
Rate for Payer: Aetna Commercial	$144.21
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.58
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.49
Rate for Payer: Qualcare PPO/HMO/WC	$72.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37

ER DEBRIDEMENT SKIN&SUBCU TISS

Facility

$706.05

Service Code	HCPCS 11042
Hospital Charge Code	5700454
Hospital Revenue Code	450
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$211.81
Rate for Payer: Aetna Medicare Advantage	$211.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.04
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.79
Rate for Payer: Qualcare PPO/HMO/WC	$105.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER DEBRIDEMENT SKIN&SUBCU TISS

Facility

$706.05

Service Code	HCPCS 11042
Hospital Charge Code	5700454
Hospital Revenue Code	450
Min. Negotiated Rate	$105.91
Max. Negotiated Rate	$105.91
Rate for Payer: Qualcare PPO/HMO/WC	$105.91

ER DEBRIDE W/RMV FB W/OPEN FRA

Facility

$3,358.50

Service Code	HCPCS 11011
Hospital Charge Code	5700670
Hospital Revenue Code	450
Min. Negotiated Rate	$503.77
Max. Negotiated Rate	$503.77
Rate for Payer: Qualcare PPO/HMO/WC	$503.77

Know your out-of-pocket cost for care.

All Charges