Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER EXTENDED - IV W/O MF

Facility

$9,086.55

Service Code	HCPCS 99284
Hospital Charge Code	5700090
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$2,725.97
Rate for Payer: Aetna Commercial	$2,725.97
Rate for Payer: Aetna Medicare Advantage	$2,725.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,317.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,317.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,317.07
Rate for Payer: Cigna Commercial	$993.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.00
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.98
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER EXTENDED - IV W/O MF

Facility

$9,086.55

Service Code	HCPCS 99284
Hospital Charge Code	5700090
Hospital Revenue Code	450
Min. Negotiated Rate	$1,362.98
Max. Negotiated Rate	$1,362.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.98

ER EXTENDED - PP IV

Facility

$2,086.55

Service Code	HCPCS 9928425
Hospital Charge Code	5700232
Hospital Revenue Code	450
Min. Negotiated Rate	$271.25
Max. Negotiated Rate	$2,481.00
Rate for Payer: Aetna Commercial	$625.97
Rate for Payer: Aetna Medicare Advantage	$625.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.07
Rate for Payer: Cigna Commercial	$1,043.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.25
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.98
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER EXTENDED - PP IV

Facility

$2,086.55

Service Code	HCPCS 9928425
Hospital Charge Code	5700232
Hospital Revenue Code	450
Min. Negotiated Rate	$312.98
Max. Negotiated Rate	$312.98
Rate for Payer: Qualcare PPO/HMO/WC	$312.98

ER EXTENDED - PP IV W/O MF

Facility

$2,086.55

Service Code	HCPCS 99284
Hospital Charge Code	5700231
Hospital Revenue Code	450
Min. Negotiated Rate	$312.98
Max. Negotiated Rate	$2,481.00
Rate for Payer: Aetna Commercial	$625.97
Rate for Payer: Aetna Medicare Advantage	$625.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.07
Rate for Payer: Cigna Commercial	$993.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.00
Rate for Payer: Oxford Commercial	$2,186.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.98
Rate for Payer: UnitedHealthcare Commercial	$2,481.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER EXTENDED - PP IV W/O MF

Facility

$2,086.55

Service Code	HCPCS 99284
Hospital Charge Code	5700231
Hospital Revenue Code	450
Min. Negotiated Rate	$312.98
Max. Negotiated Rate	$312.98
Rate for Payer: Qualcare PPO/HMO/WC	$312.98

ER-EYE EXAM/VISUAL ACUITY

Facility

$315.00

Service Code	HCPCS 92002
Hospital Charge Code	5790230
Hospital Revenue Code	450
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$317.04
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Aetna Medicare Advantage	$94.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.33
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

ER-EYE EXAM/VISUAL ACUITY

Facility

$315.00

Service Code	HCPCS 92002
Hospital Charge Code	5790230
Hospital Revenue Code	450
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$47.25
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

ER FB MUSC/TENDON SHEATH DEEP

Facility

$12,792.55

Service Code	HCPCS 20525
Hospital Charge Code	5700722
Hospital Revenue Code	450
Min. Negotiated Rate	$193.54
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$3,837.76
Rate for Payer: Aetna Medicare Advantage	$3,837.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,262.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,262.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,262.10
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,918.88

ER FB MUSC/TENDON SHEATH DEEP

Facility

$12,792.55

Service Code	HCPCS 20525
Hospital Charge Code	5700722
Hospital Revenue Code	450
Min. Negotiated Rate	$1,918.88
Max. Negotiated Rate	$1,918.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,918.88

ER FB MUSC/TENDON SHEATH SIMPL

Facility

$7,903.25

Service Code	HCPCS 20520
Hospital Charge Code	5700546
Hospital Revenue Code	450
Min. Negotiated Rate	$96.77
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,370.97
Rate for Payer: Aetna Medicare Advantage	$2,370.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,015.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,015.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,015.33
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,027.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49

ER FB MUSC/TENDON SHEATH SIMPL

Facility

$7,903.25

Service Code	HCPCS 20520
Hospital Charge Code	5700546
Hospital Revenue Code	450
Min. Negotiated Rate	$1,185.49
Max. Negotiated Rate	$1,185.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49

ER-FB RECTUM

Facility

$2,316.00

Service Code	HCPCS 46608
Hospital Charge Code	5790155
Hospital Revenue Code	450
Min. Negotiated Rate	$58.79
Max. Negotiated Rate	$2,214.60
Rate for Payer: Aetna Commercial	$694.80
Rate for Payer: Aetna Medicare Advantage	$694.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$590.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$590.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$590.58
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.08
Rate for Payer: Qualcare PPO/HMO/WC	$347.40

ER-FB RECTUM

Facility

$2,316.00

Service Code	HCPCS 46608
Hospital Charge Code	5790155
Hospital Revenue Code	450
Min. Negotiated Rate	$347.40
Max. Negotiated Rate	$347.40
Rate for Payer: Qualcare PPO/HMO/WC	$347.40

ER-FB REM CONJT SCLEM-BIL

Facility

$702.00

Hospital Charge Code	5790850
Hospital Revenue Code	450
Min. Negotiated Rate	$105.30
Max. Negotiated Rate	$105.30
Rate for Payer: Qualcare PPO/HMO/WC	$105.30

ER-FB REM CONJT SCLEM-BIL

Facility

$702.00

Hospital Charge Code	5790850
Hospital Revenue Code	450
Min. Negotiated Rate	$91.26
Max. Negotiated Rate	$351.00
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: Aetna Medicare Advantage	$210.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.01
Rate for Payer: Cigna Commercial	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.26
Rate for Payer: Qualcare PPO/HMO/WC	$105.30

ER-FB REM-CORN WOSLIT-BIL

Facility

$1,128.75

Service Code	HCPCS 65220
Hospital Charge Code	5790855
Hospital Revenue Code	450
Min. Negotiated Rate	$169.31
Max. Negotiated Rate	$169.31
Rate for Payer: Qualcare PPO/HMO/WC	$169.31

ER-FB REM-CORN WOSLIT-BIL

Facility

$1,128.75

Service Code	HCPCS 65220
Hospital Charge Code	5790855
Hospital Revenue Code	450
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$1,063.82
Rate for Payer: Aetna Commercial	$338.62
Rate for Payer: Aetna Medicare Advantage	$338.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.83
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.74
Rate for Payer: Qualcare PPO/HMO/WC	$169.31

ER-F/B REM FECAL IMPACT

Facility

$1,377.00

Service Code	HCPCS 45915
Hospital Charge Code	5790145
Hospital Revenue Code	450
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$2,849.67
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Aetna Medicare Advantage	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.13
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.01
Rate for Payer: Qualcare PPO/HMO/WC	$206.55

ER-F/B REM FECAL IMPACT

Facility

$1,377.00

Service Code	HCPCS 45915
Hospital Charge Code	5790145
Hospital Revenue Code	450
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$206.55
Rate for Payer: Qualcare PPO/HMO/WC	$206.55

ER FB REMOVAL ARM/ELBOW DEEP

Facility

$9,570.65

Service Code	HCPCS 24201
Hospital Charge Code	5700739
Hospital Revenue Code	450
Min. Negotiated Rate	$201.68
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$2,871.20
Rate for Payer: Aetna Medicare Advantage	$2,871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,440.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,440.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,440.52
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,244.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.60

ER FB REMOVAL ARM/ELBOW DEEP

Facility

$9,570.65

Service Code	HCPCS 24201
Hospital Charge Code	5700739
Hospital Revenue Code	450
Min. Negotiated Rate	$1,435.60
Max. Negotiated Rate	$1,435.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.60

ER FB REMOVAL ARM/ELBOW SQ

Facility

$2,386.20

Service Code	HCPCS 24200
Hospital Charge Code	5700738
Hospital Revenue Code	450
Min. Negotiated Rate	$357.93
Max. Negotiated Rate	$357.93
Rate for Payer: Qualcare PPO/HMO/WC	$357.93

ER FB REMOVAL ARM/ELBOW SQ

Facility

$2,386.20

Service Code	HCPCS 24200
Hospital Charge Code	5700738
Hospital Revenue Code	450
Min. Negotiated Rate	$66.41
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$715.86
Rate for Payer: Aetna Medicare Advantage	$715.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$608.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$608.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$608.48
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.21
Rate for Payer: Qualcare PPO/HMO/WC	$357.93

ER-FB REMOVAL EAR-LT

Facility

$203.00

Hospital Charge Code	5792160
Hospital Revenue Code	450
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$101.50
Rate for Payer: Aetna Commercial	$60.90
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.39
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

Know your out-of-pocket cost for care.

All Charges