Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER-LIGATION A-V FISTULA

Facility

$8,339.00

Service Code	HCPCS 37607
Hospital Charge Code	5790115
Hospital Revenue Code	450
Min. Negotiated Rate	$1,250.85
Max. Negotiated Rate	$1,250.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,250.85

ER-LIGATION A-V FISTULA

Facility

$8,339.00

Service Code	HCPCS 37607
Hospital Charge Code	5790115
Hospital Revenue Code	450
Min. Negotiated Rate	$402.50
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$2,501.70
Rate for Payer: Aetna Medicare Advantage	$2,501.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,126.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,126.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,126.45
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,084.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,250.85

ER LIMITED - II

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700117
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$1,851.70
Rate for Payer: Aetna Commercial	$1,851.70
Rate for Payer: Aetna Medicare Advantage	$1,851.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,573.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,573.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,573.95
Rate for Payer: Cigna Commercial	$365.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.00
Rate for Payer: Oxford Commercial	$673.00
Rate for Payer: Qualcare PPO/HMO/WC	$925.85
Rate for Payer: UnitedHealthcare Commercial	$763.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - II

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700117
Hospital Revenue Code	450
Min. Negotiated Rate	$925.85
Max. Negotiated Rate	$925.85
Rate for Payer: Qualcare PPO/HMO/WC	$925.85

ER LIMITED - II W/O MF

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700116
Hospital Revenue Code	450
Min. Negotiated Rate	$925.85
Max. Negotiated Rate	$925.85
Rate for Payer: Qualcare PPO/HMO/WC	$925.85

ER LIMITED - II W/O MF

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700116
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$1,851.70
Rate for Payer: Aetna Commercial	$1,851.70
Rate for Payer: Aetna Medicare Advantage	$1,851.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,573.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,573.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,573.95
Rate for Payer: Cigna Commercial	$365.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.00
Rate for Payer: Oxford Commercial	$673.00
Rate for Payer: Qualcare PPO/HMO/WC	$925.85
Rate for Payer: UnitedHealthcare Commercial	$763.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - PP II

Facility

$838.75

Service Code	HCPCS 9928225
Hospital Charge Code	5700216
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$125.81
Rate for Payer: Qualcare PPO/HMO/WC	$125.81

ER LIMITED - PP II

Facility

$838.75

Service Code	HCPCS 9928225
Hospital Charge Code	5700216
Hospital Revenue Code	450
Min. Negotiated Rate	$109.04
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$251.62
Rate for Payer: Aetna Medicare Advantage	$251.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.88
Rate for Payer: Cigna Commercial	$419.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.04
Rate for Payer: Qualcare PPO/HMO/WC	$125.81
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - PP II W/O MF

Facility

$838.75

Service Code	HCPCS 99282
Hospital Charge Code	5700215
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$763.00
Rate for Payer: Aetna Commercial	$251.62
Rate for Payer: Aetna Medicare Advantage	$251.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.88
Rate for Payer: Cigna Commercial	$365.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.00
Rate for Payer: Oxford Commercial	$673.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.81
Rate for Payer: UnitedHealthcare Commercial	$763.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - PP II W/O MF

Facility

$838.75

Service Code	HCPCS 99282
Hospital Charge Code	5700215
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$125.81
Rate for Payer: Qualcare PPO/HMO/WC	$125.81

ER LUMBAR PUNCTURE DIAGNOSTIC

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	5700803
Hospital Revenue Code	450
Min. Negotiated Rate	$477.86
Max. Negotiated Rate	$477.86
Rate for Payer: Qualcare PPO/HMO/WC	$477.86

ER LUMBAR PUNCTURE DIAGNOSTIC

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	5700803
Hospital Revenue Code	450
Min. Negotiated Rate	$414.15
Max. Negotiated Rate	$1,680.99
Rate for Payer: Aetna Commercial	$955.73
Rate for Payer: Aetna Medicare Advantage	$955.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$812.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$812.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$812.37
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.15
Rate for Payer: Qualcare PPO/HMO/WC	$477.86

ER LWBS WITH DOLLAR CHARGE

Facility

$1.00

Service Code	HCPCS LWBS1
Hospital Charge Code	5700001
Hospital Revenue Code	450
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

ER LWBS WITH DOLLAR CHARGE

Facility

$1.00

Service Code	HCPCS LWBS1
Hospital Charge Code	5700001
Hospital Revenue Code	450
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

ER-MAJOR JNT SH, KNEE-BIL

Facility

$697.00

Hospital Charge Code	5790305
Hospital Revenue Code	450
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

ER-MAJOR JNT SH, KNEE-BIL

Facility

$697.00

Hospital Charge Code	5790305
Hospital Revenue Code	450
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

ER-MATERNITY CARE OTHER

Facility

$500.00

Service Code	HCPCS 59899
Hospital Charge Code	5790210
Hospital Revenue Code	450
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$481.45
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

ER-MATERNITY CARE OTHER

Facility

$500.00

Service Code	HCPCS 59899
Hospital Charge Code	5790210
Hospital Revenue Code	450
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

ER MD VENIPNCTR<AGE 3 FEM/JUG

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5700631
Hospital Revenue Code	450
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$90.38
Rate for Payer: Aetna Commercial	$90.38
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$13.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

ER MD VENIPNCTR<AGE 3 FEM/JUG

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5700631
Hospital Revenue Code	450
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

ER MD VENIPUNCTR <3Y NOT ROUTI

Facility

$301.25

Service Code	HCPCS 36406
Hospital Charge Code	5700778
Hospital Revenue Code	450
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$90.38
Rate for Payer: Aetna Commercial	$90.38
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

ER MD VENIPUNCTR <3Y NOT ROUTI

Facility

$301.25

Service Code	HCPCS 36406
Hospital Charge Code	5700778
Hospital Revenue Code	450
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

ER MD VENIPUNCTR > AGE 3

Facility

$285.00

Service Code	HCPCS 36410
Hospital Charge Code	5700633
Hospital Revenue Code	450
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$42.75
Rate for Payer: Qualcare PPO/HMO/WC	$42.75

ER MD VENIPUNCTR > AGE 3

Facility

$285.00

Service Code	HCPCS 36410
Hospital Charge Code	5700633
Hospital Revenue Code	450
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.67
Rate for Payer: Cigna Commercial	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$42.75

ER MD VENIPUNCTR FEM/JUG <3YRS

Facility

$301.25

Service Code	HCPCS 36400
Hospital Charge Code	5700777
Hospital Revenue Code	450
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$90.38
Rate for Payer: Aetna Commercial	$90.38
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$16.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

Know your out-of-pocket cost for care.

All Charges