Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$69.22
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$159.75
Rate for Payer: Aetna Medicare Advantage	$159.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.79
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.22
Rate for Payer: Qualcare PPO/HMO/WC	$79.88

ER SIM REP NEK TO TRUNK12.6-20

Facility

$787.87

Service Code	HCPCS 12005
Hospital Charge Code	5700517
Hospital Revenue Code	450
Min. Negotiated Rate	$118.18
Max. Negotiated Rate	$118.18
Rate for Payer: Qualcare PPO/HMO/WC	$118.18

ER SIM REP NEK TO TRUNK12.6-20

Facility

$787.87

Service Code	HCPCS 12005
Hospital Charge Code	5700517
Hospital Revenue Code	450
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$236.36
Rate for Payer: Aetna Medicare Advantage	$236.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.91
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.42
Rate for Payer: Qualcare PPO/HMO/WC	$118.18

ER SIM WOUND DEHIS REP W/PACK

Facility

$1,723.35

Service Code	HCPCS 12021
Hospital Charge Code	5700707
Hospital Revenue Code	450
Min. Negotiated Rate	$258.50
Max. Negotiated Rate	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.50

ER SIM WOUND DEHIS REP W/PACK

Facility

$1,723.35

Service Code	HCPCS 12021
Hospital Charge Code	5700707
Hospital Revenue Code	450
Min. Negotiated Rate	$75.07
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	$75.07
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 SKIN AUTOGRAFT

Facility

$949.00

Service Code	HCPCS 15120
Hospital Charge Code	5790117
Hospital Revenue Code	450
Min. Negotiated Rate	$142.35
Max. Negotiated Rate	$142.35
Rate for Payer: Qualcare PPO/HMO/WC	$142.35

ER SKIN AUTOGRAFT

Facility

$949.00

Service Code	HCPCS 15120
Hospital Charge Code	5790117
Hospital Revenue Code	450
Min. Negotiated Rate	$123.37
Max. Negotiated Rate	$8,439.01
Rate for Payer: Aetna Commercial	$284.70
Rate for Payer: Aetna Medicare Advantage	$284.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$559.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.00
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.37
Rate for Payer: Qualcare PPO/HMO/WC	$142.35

ER-SKIN GRAFT SLP/ARM/LEG

Facility

$4,977.00

Service Code	HCPCS 15220
Hospital Charge Code	5790035
Hospital Revenue Code	450
Min. Negotiated Rate	$746.55
Max. Negotiated Rate	$746.55
Rate for Payer: Qualcare PPO/HMO/WC	$746.55

ER-SKIN GRAFT SLP/ARM/LEG

Facility

$4,977.00

Service Code	HCPCS 15220
Hospital Charge Code	5790035
Hospital Revenue Code	450
Min. Negotiated Rate	$335.17
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$1,493.10
Rate for Payer: Aetna Medicare Advantage	$1,493.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,269.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,269.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$335.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,269.13
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$647.01
Rate for Payer: Qualcare PPO/HMO/WC	$746.55

ER-SKIN TISSUE REARRANGMT

Facility

$9,070.55

Service Code	HCPCS 14040
Hospital Charge Code	5790020
Hospital Revenue Code	450
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Better Health Medicaid	$64.50
Rate for Payer: Aetna Commercial	$2,721.16
Rate for Payer: Aetna Medicare Advantage	$2,721.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,312.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,312.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,312.99
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65.79

ER-SKIN TISSUE REARRANGMT

Facility

$9,070.55

Service Code	HCPCS 14040
Hospital Charge Code	5790020
Hospital Revenue Code	450
Min. Negotiated Rate	$1,360.58
Max. Negotiated Rate	$1,360.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58

ER-SMALL JOINT BURSA-BILA

Facility

$697.00

Hospital Charge Code	5790295
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-SMALL JOINT BURSA-BILA

Facility

$697.00

Hospital Charge Code	5790295
Hospital Revenue Code	450
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

ER SMKG/TOBAC COUNSEL 4-10 M

Facility

$188.60

Service Code	HCPCS 99406
Hospital Charge Code	5700819
Hospital Revenue Code	942
Min. Negotiated Rate	$28.29
Max. Negotiated Rate	$28.29
Rate for Payer: Qualcare PPO/HMO/WC	$28.29

ER SMKG/TOBAC COUNSEL 4-10 M

Facility

$188.60

Service Code	HCPCS 99406
Hospital Charge Code	5700819
Hospital Revenue Code	942
Min. Negotiated Rate	$24.52
Max. Negotiated Rate	$779.00
Rate for Payer: Aetna Commercial	$56.58
Rate for Payer: Aetna Medicare Advantage	$56.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.09
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.52
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.29
Rate for Payer: UnitedHealthcare Commercial	$779.00

ER-SMOKE CESSAT >10 MINS

Facility

$221.00

Service Code	HCPCS 99407
Hospital Charge Code	5790255
Hospital Revenue Code	942
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$779.00
Rate for Payer: Aetna Commercial	$66.30
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.73
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Commercial	$779.00

ER-SMOKE CESSAT >10 MINS

Facility

$221.00

Service Code	HCPCS 99407
Hospital Charge Code	5790255
Hospital Revenue Code	942
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

ER SPLINT LONG LEG

Facility

$777.42

Service Code	HCPCS 29505
Hospital Charge Code	5700450
Hospital Revenue Code	450
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

ER SPLINT LONG LEG

Facility

$777.42

Service Code	HCPCS 29505
Hospital Charge Code	5700450
Hospital Revenue Code	450
Min. Negotiated Rate	$55.20
Max. Negotiated Rate	$386.97
Rate for Payer: Aetna Commercial	$233.23
Rate for Payer: Aetna Medicare Advantage	$233.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.24
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.06
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

ER STAPPING ELBOW OR WRIST

Facility

$348.75

Service Code	HCPCS 29260
Hospital Charge Code	5700613
Hospital Revenue Code	450
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

ER STAPPING ELBOW OR WRIST

Facility

$348.75

Service Code	HCPCS 29260
Hospital Charge Code	5700613
Hospital Revenue Code	450
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$104.62
Rate for Payer: Aetna Medicare Advantage	$104.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.93
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

ER-STOMACH PROCEDURE-OTHR

Facility

$2,601.00

Service Code	HCPCS 43999
Hospital Charge Code	5790140
Hospital Revenue Code	450
Min. Negotiated Rate	$390.15
Max. Negotiated Rate	$390.15
Rate for Payer: Qualcare PPO/HMO/WC	$390.15

ER-STOMACH PROCEDURE-OTHR

Facility

$2,601.00

Service Code	HCPCS 43999
Hospital Charge Code	5790140
Hospital Revenue Code	450
Min. Negotiated Rate	$338.13
Max. Negotiated Rate	$2,159.89
Rate for Payer: Aetna Commercial	$780.30
Rate for Payer: Aetna Medicare Advantage	$780.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$663.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$663.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$663.25
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.13
Rate for Payer: Qualcare PPO/HMO/WC	$390.15

ER STRAPPING ANKLE AND/OR FOOT

Facility

$348.75

Service Code	HCPCS 29540
Hospital Charge Code	5700615
Hospital Revenue Code	450
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$386.97
Rate for Payer: Aetna Commercial	$104.62
Rate for Payer: Aetna Medicare Advantage	$104.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.93
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	$88.93
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

ER STRAPPING ANKLE AND/OR FOOT

Facility

$348.75

Service Code	HCPCS 29540
Hospital Charge Code	5700615
Hospital Revenue Code	450
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

Know your out-of-pocket cost for care.

All Charges