Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER-INTRA-AORTIC BALLOON CATH

Facility

$22,823.38

Service Code	HCPCS 33967
Hospital Charge Code	5780180
Hospital Revenue Code	361
Min. Negotiated Rate	$3,423.51
Max. Negotiated Rate	$3,423.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,423.51

ER INTRA ARTERIAL INFUSION

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	5700440
Hospital Revenue Code	450
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ER INTRA ARTERIAL INFUSION

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	5700440
Hospital Revenue Code	450
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$506.53
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ER INTRAOSSEOUS INFUSION

Facility

$1,550.25

Service Code	HCPCS 36680
Hospital Charge Code	5700784
Hospital Revenue Code	450
Min. Negotiated Rate	$42.55
Max. Negotiated Rate	$1,063.82
Rate for Payer: Aetna Commercial	$465.07
Rate for Payer: Aetna Medicare Advantage	$465.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.31
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.53
Rate for Payer: Qualcare PPO/HMO/WC	$232.54

ER INTRAOSSEOUS INFUSION

Facility

$1,550.25

Service Code	HCPCS 36680
Hospital Charge Code	5700784
Hospital Revenue Code	450
Min. Negotiated Rate	$232.54
Max. Negotiated Rate	$232.54
Rate for Payer: Qualcare PPO/HMO/WC	$232.54

ER INT REP FACE 12.6-20

Facility

$2,305.60

Service Code	HCPCS 12055
Hospital Charge Code	5700538
Hospital Revenue Code	450
Min. Negotiated Rate	$180.11
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$691.68
Rate for Payer: Aetna Medicare Advantage	$691.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.93
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.73
Rate for Payer: Qualcare PPO/HMO/WC	$345.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER INT REP FACE 12.6-20

Facility

$2,305.60

Service Code	HCPCS 12055
Hospital Charge Code	5700538
Hospital Revenue Code	450
Min. Negotiated Rate	$345.84
Max. Negotiated Rate	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$345.84

ER INT REP FACE 20.1-30

Facility

$1,723.35

Service Code	HCPCS 12056
Hospital Charge Code	5700713
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER INT REP FACE 20.1-30

Facility

$1,723.35

Service Code	HCPCS 12056
Hospital Charge Code	5700713
Hospital Revenue Code	450
Min. Negotiated Rate	$224.04
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
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	$243.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.45
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.04
Rate for Payer: Qualcare PPO/HMO/WC	$258.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER INT REP FACE 2.5-5.0

Facility

$687.50

Service Code	HCPCS 12052
Hospital Charge Code	5700535
Hospital Revenue Code	450
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$103.12

ER INT REP FACE 2.5-5.0

Facility

$687.50

Service Code	HCPCS 12052
Hospital Charge Code	5700535
Hospital Revenue Code	450
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$206.25
Rate for Payer: Aetna Medicare Advantage	$206.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.31
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.38
Rate for Payer: Qualcare PPO/HMO/WC	$103.12

ER INT REP FACE > 30 CM

Facility

$1,723.35

Service Code	HCPCS 12057
Hospital Charge Code	5700714
Hospital Revenue Code	450
Min. Negotiated Rate	$224.04
Max. Negotiated Rate	$968.07
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	$243.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.45
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.04
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER INT REP FACE > 30 CM

Facility

$1,723.35

Service Code	HCPCS 12057
Hospital Charge Code	5700714
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER INT REP FACE 5.1-7.5

Facility

$1,813.80

Service Code	HCPCS 12053
Hospital Charge Code	5700536
Hospital Revenue Code	450
Min. Negotiated Rate	$127.31
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$544.14
Rate for Payer: Aetna Medicare Advantage	$544.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$462.52
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.79
Rate for Payer: Qualcare PPO/HMO/WC	$272.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER INT REP FACE 5.1-7.5

Facility

$1,813.80

Service Code	HCPCS 12053
Hospital Charge Code	5700536
Hospital Revenue Code	450
Min. Negotiated Rate	$272.07
Max. Negotiated Rate	$272.07
Rate for Payer: Qualcare PPO/HMO/WC	$272.07

ER INT REP FACE 7.6-12.5

Facility

$737.50

Service Code	HCPCS 12054
Hospital Charge Code	5700537
Hospital Revenue Code	450
Min. Negotiated Rate	$110.62
Max. Negotiated Rate	$110.62
Rate for Payer: Qualcare PPO/HMO/WC	$110.62

ER INT REP FACE 7.6-12.5

Facility

$737.50

Service Code	HCPCS 12054
Hospital Charge Code	5700537
Hospital Revenue Code	450
Min. Negotiated Rate	$95.88
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$221.25
Rate for Payer: Aetna Medicare Advantage	$221.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.06
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.88
Rate for Payer: Qualcare PPO/HMO/WC	$110.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER INT REP FACE UP TO 2.5

Facility

$668.75

Service Code	HCPCS 12051
Hospital Charge Code	5700534
Hospital Revenue Code	450
Min. Negotiated Rate	$100.31
Max. Negotiated Rate	$100.31
Rate for Payer: Qualcare PPO/HMO/WC	$100.31

ER INT REP FACE UP TO 2.5

Facility

$668.75

Service Code	HCPCS 12051
Hospital Charge Code	5700534
Hospital Revenue Code	450
Min. Negotiated Rate	$86.94
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$200.62
Rate for Payer: Aetna Medicare Advantage	$200.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.53
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.94
Rate for Payer: Qualcare PPO/HMO/WC	$100.31

ER INT REP NEK HAD FOOT2.6-7.5

Facility

$687.50

Service Code	HCPCS 12042
Hospital Charge Code	5700532
Hospital Revenue Code	450
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$103.12

ER INT REP NEK HAD FOOT2.6-7.5

Facility

$687.50

Service Code	HCPCS 12042
Hospital Charge Code	5700532
Hospital Revenue Code	450
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$206.25
Rate for Payer: Aetna Medicare Advantage	$206.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.31
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.38
Rate for Payer: Qualcare PPO/HMO/WC	$103.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER INT REP NEK HAD FOT12.6-20

Facility

$1,723.35

Service Code	HCPCS 12045
Hospital Charge Code	5700710
Hospital Revenue Code	450
Min. Negotiated Rate	$181.08
Max. Negotiated Rate	$1,760.02
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	$181.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.45
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.04
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER INT REP NEK HAD FOT12.6-20

Facility

$1,723.35

Service Code	HCPCS 12045
Hospital Charge Code	5700710
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER INT REP NEK HAD FOT20.1-30

Facility

$1,723.35

Service Code	HCPCS 12046
Hospital Charge Code	5700711
Hospital Revenue Code	450
Min. Negotiated Rate	$219.73
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
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	$219.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.45
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.04
Rate for Payer: Qualcare PPO/HMO/WC	$258.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

ER INT REP NEK HAD FOT20.1-30

Facility

$1,723.35

Service Code	HCPCS 12046
Hospital Charge Code	5700711
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

Know your out-of-pocket cost for care.

All Charges