Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER SHORT ARM CAST

Facility

$1,391.15

Service Code	HCPCS 29075
Hospital Charge Code	5700773
Hospital Revenue Code	450
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$1,472.81
Rate for Payer: Aetna Better Health Medicaid	$1,443.93
Rate for Payer: Aetna Commercial	$417.35
Rate for Payer: Aetna Medicare Advantage	$417.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.74
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.85
Rate for Payer: Qualcare PPO/HMO/WC	$208.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,472.81

ER SHORT ARM CAST

Facility

$1,391.15

Service Code	HCPCS 29075
Hospital Charge Code	5700773
Hospital Revenue Code	450
Min. Negotiated Rate	$208.67
Max. Negotiated Rate	$208.67
Rate for Payer: Qualcare PPO/HMO/WC	$208.67

ER-SHOULD DISLO W/FX-BI

Facility

$498.00

Hospital Charge Code	5790360
Hospital Revenue Code	450
Min. Negotiated Rate	$64.74
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$149.40
Rate for Payer: Aetna Medicare Advantage	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.99
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.74
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

ER-SHOULD DISLO W/FX-BI

Facility

$498.00

Hospital Charge Code	5790360
Hospital Revenue Code	450
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

ER-SHOULDER DISLOCAT-BILA

Facility

$612.00

Hospital Charge Code	5790350
Hospital Revenue Code	450
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

ER-SHOULDER DISLOCAT-BILA

Facility

$612.00

Hospital Charge Code	5790350
Hospital Revenue Code	450
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: Aetna Medicare Advantage	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.06
Rate for Payer: Cigna Commercial	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.56
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

ER SIMPLE WOUND DEHISCE REPAIR

Facility

$980.51

Service Code	HCPCS 12020
Hospital Charge Code	5700706
Hospital Revenue Code	450
Min. Negotiated Rate	$118.82
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$294.15
Rate for Payer: Aetna Medicare Advantage	$294.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.03
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.47
Rate for Payer: Qualcare PPO/HMO/WC	$147.08

ER SIMPLE WOUND DEHISCE REPAIR

Facility

$980.51

Service Code	HCPCS 12020
Hospital Charge Code	5700706
Hospital Revenue Code	450
Min. Negotiated Rate	$147.08
Max. Negotiated Rate	$147.08
Rate for Payer: Qualcare PPO/HMO/WC	$147.08

ER SIM REP FACE 12.6-20

Facility

$3,189.20

Service Code	HCPCS 12016
Hospital Charge Code	5700524
Hospital Revenue Code	450
Min. Negotiated Rate	$478.38
Max. Negotiated Rate	$478.38
Rate for Payer: Qualcare PPO/HMO/WC	$478.38

ER SIM REP FACE 12.6-20

Facility

$3,189.20

Service Code	HCPCS 12016
Hospital Charge Code	5700524
Hospital Revenue Code	450
Min. Negotiated Rate	$150.65
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$956.76
Rate for Payer: Aetna Medicare Advantage	$956.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$813.25
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.60
Rate for Payer: Qualcare PPO/HMO/WC	$478.38

ER SIM REP FACE 20.1-30

Facility

$2,700.00

Service Code	HCPCS 12017
Hospital Charge Code	5700525
Hospital Revenue Code	450
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

ER SIM REP FACE 20.1-30

Facility

$2,700.00

Service Code	HCPCS 12017
Hospital Charge Code	5700525
Hospital Revenue Code	450
Min. Negotiated Rate	$132.78
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

ER SIM REP FACE 2.6-5

Facility

$425.00

Service Code	HCPCS 12013
Hospital Charge Code	5700521
Hospital Revenue Code	450
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

ER SIM REP FACE 2.6-5

Facility

$425.00

Service Code	HCPCS 12013
Hospital Charge Code	5700521
Hospital Revenue Code	450
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$554.01
Rate for Payer: Aetna Better Health Medicaid	$543.15
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$554.01

ER SIM REP FACE 5.1-7.5

Facility

$432.50

Service Code	HCPCS 12014
Hospital Charge Code	5700522
Hospital Revenue Code	450
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$129.75
Rate for Payer: Aetna Medicare Advantage	$129.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.29
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.23
Rate for Payer: Qualcare PPO/HMO/WC	$64.88

ER SIM REP FACE 5.1-7.5

Facility

$432.50

Service Code	HCPCS 12014
Hospital Charge Code	5700522
Hospital Revenue Code	450
Min. Negotiated Rate	$64.88
Max. Negotiated Rate	$64.88
Rate for Payer: Qualcare PPO/HMO/WC	$64.88

ER SIM REP FACE 7.6-12.5

Facility

$438.75

Service Code	HCPCS 12015
Hospital Charge Code	5700523
Hospital Revenue Code	450
Min. Negotiated Rate	$65.81
Max. Negotiated Rate	$65.81
Rate for Payer: Qualcare PPO/HMO/WC	$65.81

ER SIM REP FACE 7.6-12.5

Facility

$438.75

Service Code	HCPCS 12015
Hospital Charge Code	5700523
Hospital Revenue Code	450
Min. Negotiated Rate	$57.04
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$131.62
Rate for Payer: Aetna Medicare Advantage	$131.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.88
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.04
Rate for Payer: Qualcare PPO/HMO/WC	$65.81

ER SIM REP FACE OVER 30

Facility

$562.50

Service Code	HCPCS 12018
Hospital Charge Code	5700526
Hospital Revenue Code	450
Min. Negotiated Rate	$73.12
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$168.75
Rate for Payer: Aetna Medicare Advantage	$168.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.44
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.12
Rate for Payer: Qualcare PPO/HMO/WC	$84.38

ER SIM REP FACE OVER 30

Facility

$562.50

Service Code	HCPCS 12018
Hospital Charge Code	5700526
Hospital Revenue Code	450
Min. Negotiated Rate	$84.38
Max. Negotiated Rate	$84.38
Rate for Payer: Qualcare PPO/HMO/WC	$84.38

ER SIM REP FACE UPTO 2.5

Facility

$3,286.55

Service Code	HCPCS 12011
Hospital Charge Code	5700520
Hospital Revenue Code	450
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$985.97
Rate for Payer: Aetna Commercial	$985.97
Rate for Payer: Aetna Medicare Advantage	$985.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$838.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$838.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$838.07
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.25
Rate for Payer: Qualcare PPO/HMO/WC	$492.98

ER SIM REP FACE UPTO 2.5

Facility

$3,286.55

Service Code	HCPCS 12011
Hospital Charge Code	5700520
Hospital Revenue Code	450
Min. Negotiated Rate	$492.98
Max. Negotiated Rate	$492.98
Rate for Payer: Qualcare PPO/HMO/WC	$492.98

ER SIM REP NCK TO TRUN OVER 30

Facility

$562.50

Service Code	HCPCS 12007
Hospital Charge Code	5700519
Hospital Revenue Code	450
Min. Negotiated Rate	$73.12
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$168.75
Rate for Payer: Aetna Medicare Advantage	$168.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.44
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.12
Rate for Payer: Qualcare PPO/HMO/WC	$84.38

ER SIM REP NCK TO TRUN OVER 30

Facility

$562.50

Service Code	HCPCS 12007
Hospital Charge Code	5700519
Hospital Revenue Code	450
Min. Negotiated Rate	$84.38
Max. Negotiated Rate	$84.38
Rate for Payer: Qualcare PPO/HMO/WC	$84.38

ER SIM REP NEK TO TRUN20.1-30

Facility

$532.50

Service Code	HCPCS 12006
Hospital Charge Code	5700518
Hospital Revenue Code	450
Min. Negotiated Rate	$79.88
Max. Negotiated Rate	$79.88
Rate for Payer: Qualcare PPO/HMO/WC	$79.88

Know your out-of-pocket cost for care.

All Charges