Heights University Hospital

All Charges

Charge

Type

Setting

Price

ERTHROPOIETIN INJ 20.000U****

Facility

$437.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017321
Hospital Revenue Code	634
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$65.55
Rate for Payer: Qualcare PPO/HMO/WC	$65.55

ERTHROPOIETIN INJ 20.000U****

Facility

$437.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017321
Hospital Revenue Code	634
Min. Negotiated Rate	$56.81
Max. Negotiated Rate	$218.50
Rate for Payer: Aetna Commercial	$131.10
Rate for Payer: Aetna Medicare Advantage	$131.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.44
Rate for Payer: Cigna Commercial	$218.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Oxford Commercial	$218.50
Rate for Payer: Qualcare PPO/HMO/WC	$65.55
Rate for Payer: UnitedHealthcare Commercial	$218.50

ER-TMJ - DISLOCATED-BILAT

Facility

$573.00

Hospital Charge Code	5790315
Hospital Revenue Code	450
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

ER-TMJ - DISLOCATED-BILAT

Facility

$573.00

Hospital Charge Code	5790315
Hospital Revenue Code	450
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$286.50
Rate for Payer: Aetna Commercial	$171.90
Rate for Payer: Aetna Medicare Advantage	$171.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.12
Rate for Payer: Cigna Commercial	$286.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.49
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

ER-TONGUE & MOUTH-OTHER

Facility

$323.00

Service Code	HCPCS 41599
Hospital Charge Code	5790135
Hospital Revenue Code	450
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$48.45
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

ER-TONGUE & MOUTH-OTHER

Facility

$323.00

Service Code	HCPCS 41599
Hospital Charge Code	5790135
Hospital Revenue Code	450
Min. Negotiated Rate	$41.99
Max. Negotiated Rate	$564.04
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare Advantage	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.36
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.99
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

ER TOOTH EXTRACTION/ANESTHESIA

Facility

$463.00

Service Code	HCPCS 41899
Hospital Charge Code	5770055
Hospital Revenue Code	450
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$564.04
Rate for Payer: Aetna Commercial	$138.90
Rate for Payer: Aetna Medicare Advantage	$138.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.06
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.19
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

ER TOOTH EXTRACTION/ANESTHESIA

Facility

$463.00

Service Code	HCPCS 41899
Hospital Charge Code	5770055
Hospital Revenue Code	450
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

ER TRACHEOTOMY TUBE CHANGE

Facility

$431.25

Service Code	HCPCS 31502
Hospital Charge Code	5700620
Hospital Revenue Code	450
Min. Negotiated Rate	$64.69
Max. Negotiated Rate	$64.69
Rate for Payer: Qualcare PPO/HMO/WC	$64.69

ER TRACHEOTOMY TUBE CHANGE

Facility

$431.25

Service Code	HCPCS 31502
Hospital Charge Code	5700620
Hospital Revenue Code	450
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$564.04
Rate for Payer: Aetna Commercial	$129.38
Rate for Payer: Aetna Medicare Advantage	$129.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.97
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.69

ER TREAT ANKLE DISLOCATION

Facility

$2,792.10

Service Code	HCPCS 27840
Hospital Charge Code	5700325
Hospital Revenue Code	450
Min. Negotiated Rate	$147.31
Max. Negotiated Rate	$837.63
Rate for Payer: Aetna Commercial	$837.63
Rate for Payer: Aetna Medicare Advantage	$837.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$711.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$711.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$711.99
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.97
Rate for Payer: Qualcare PPO/HMO/WC	$418.81

ER TREAT ANKLE DISLOCATION

Facility

$2,792.10

Service Code	HCPCS 27840
Hospital Charge Code	5700325
Hospital Revenue Code	450
Min. Negotiated Rate	$418.81
Max. Negotiated Rate	$418.81
Rate for Payer: Qualcare PPO/HMO/WC	$418.81

ER-TREAT BIG TOE FX-BI

Facility

$457.00

Hospital Charge Code	5790650
Hospital Revenue Code	450
Min. Negotiated Rate	$68.55
Max. Negotiated Rate	$68.55
Rate for Payer: Qualcare PPO/HMO/WC	$68.55

ER-TREAT BIG TOE FX-BI

Facility

$457.00

Hospital Charge Code	5790650
Hospital Revenue Code	450
Min. Negotiated Rate	$59.41
Max. Negotiated Rate	$228.50
Rate for Payer: Aetna Commercial	$137.10
Rate for Payer: Aetna Medicare Advantage	$137.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.53
Rate for Payer: Cigna Commercial	$228.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.41
Rate for Payer: Qualcare PPO/HMO/WC	$68.55

ER TREAT ELBOW DISLOCATION

Facility

$388.60

Service Code	HCPCS 24600
Hospital Charge Code	5700313
Hospital Revenue Code	450
Min. Negotiated Rate	$50.52
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$116.58
Rate for Payer: Aetna Medicare Advantage	$116.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.09
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.52
Rate for Payer: Qualcare PPO/HMO/WC	$58.29

ER TREAT ELBOW DISLOCATION

Facility

$388.60

Service Code	HCPCS 24600
Hospital Charge Code	5700313
Hospital Revenue Code	450
Min. Negotiated Rate	$58.29
Max. Negotiated Rate	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$58.29

ER TREAT FINGER DISLOCATION

Facility

$388.60

Service Code	HCPCS 26700
Hospital Charge Code	5700323
Hospital Revenue Code	450
Min. Negotiated Rate	$58.29
Max. Negotiated Rate	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$58.29

ER TREAT FINGER DISLOCATION

Facility

$388.60

Service Code	HCPCS 26700
Hospital Charge Code	5700323
Hospital Revenue Code	450
Min. Negotiated Rate	$50.52
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$116.58
Rate for Payer: Aetna Medicare Advantage	$116.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.09
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	$99.09
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.52
Rate for Payer: Qualcare PPO/HMO/WC	$58.29

ER TREAT FINGER DISLOCATION

Facility

$11,949.75

Service Code	HCPCS 26785
Hospital Charge Code	5790900
Hospital Revenue Code	450
Min. Negotiated Rate	$1,792.46
Max. Negotiated Rate	$1,792.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.46

ER TREAT FINGER DISLOCATION

Facility

$11,949.75

Service Code	HCPCS 26785
Hospital Charge Code	5790900
Hospital Revenue Code	450
Min. Negotiated Rate	$147.31
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$3,584.93
Rate for Payer: Aetna Medicare Advantage	$3,584.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.19
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,553.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.46

ER TREAT HAND DISLOCATION

Facility

$1,175.15

Service Code	HCPCS 26670
Hospital Charge Code	5700580
Hospital Revenue Code	450
Min. Negotiated Rate	$62.62
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$352.55
Rate for Payer: Aetna Medicare Advantage	$352.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.66
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.77
Rate for Payer: Qualcare PPO/HMO/WC	$176.27

ER TREAT HAND DISLOCATION

Facility

$1,175.15

Service Code	HCPCS 26670
Hospital Charge Code	5700580
Hospital Revenue Code	450
Min. Negotiated Rate	$176.27
Max. Negotiated Rate	$176.27
Rate for Payer: Qualcare PPO/HMO/WC	$176.27

ER TREAT HIP DISLOATION W ANES

Facility

$6,125.00

Service Code	HCPCS 27252
Hospital Charge Code	5700688
Hospital Revenue Code	450
Min. Negotiated Rate	$362.25
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,837.50
Rate for Payer: Aetna Medicare Advantage	$1,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.88
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$796.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

ER TREAT HIP DISLOATION W ANES

Facility

$6,125.00

Service Code	HCPCS 27252
Hospital Charge Code	5700688
Hospital Revenue Code	450
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$918.75
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

ER TREAT KNUCKLE DISLOCATION

Facility

$7,690.80

Service Code	HCPCS 26705
Hospital Charge Code	5792265
Hospital Revenue Code	450
Min. Negotiated Rate	$154.66
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,307.24
Rate for Payer: Aetna Medicare Advantage	$2,307.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,961.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,961.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,961.15
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.62

Know your out-of-pocket cost for care.

All Charges