Heights University Hospital

All Charges

Charge

Type

Setting

Price

ER TREAT KNUCKLE DISLOCATION

Facility

$7,690.80

Service Code	HCPCS 26705
Hospital Charge Code	5792265
Hospital Revenue Code	450
Min. Negotiated Rate	$1,153.62
Max. Negotiated Rate	$1,153.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.62

ER TREAT SHOULDER DISLOCATION

Facility

$5,408.58

Service Code	HCPCS 23655
Hospital Charge Code	5700315
Hospital Revenue Code	450
Min. Negotiated Rate	$811.29
Max. Negotiated Rate	$811.29
Rate for Payer: Qualcare PPO/HMO/WC	$811.29

ER TREAT SHOULDER DISLOCATION

Facility

$5,408.58

Service Code	HCPCS 23655
Hospital Charge Code	5700315
Hospital Revenue Code	450
Min. Negotiated Rate	$147.31
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,622.57
Rate for Payer: Aetna Medicare Advantage	$1,622.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,379.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,379.19
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	$1,379.19
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$703.12
Rate for Payer: Qualcare PPO/HMO/WC	$811.29

ER TREAT WRIST DISLOCATION

Facility

$387.10

Service Code	HCPCS 25660
Hospital Charge Code	5700360
Hospital Revenue Code	450
Min. Negotiated Rate	$50.32
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$116.13
Rate for Payer: Aetna Medicare Advantage	$116.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.71
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	$98.71
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.32
Rate for Payer: Qualcare PPO/HMO/WC	$58.06

ER TREAT WRIST DISLOCATION

Facility

$387.10

Service Code	HCPCS 25660
Hospital Charge Code	5700360
Hospital Revenue Code	450
Min. Negotiated Rate	$58.06
Max. Negotiated Rate	$58.06
Rate for Payer: Qualcare PPO/HMO/WC	$58.06

ER TRIDIL DRIP PROCEDURE***

Facility

$84.00

Hospital Charge Code	8004046
Hospital Revenue Code	272
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

ER TRIDIL DRIP PROCEDURE***

Facility

$84.00

Hospital Charge Code	8004046
Hospital Revenue Code	272
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.92
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$42.00

ER-TRIGGER POINT INJ

Facility

$1,434.65

Service Code	HCPCS 20552
Hospital Charge Code	5790060
Hospital Revenue Code	450
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$430.39
Rate for Payer: Aetna Medicare Advantage	$430.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.50
Rate for Payer: Qualcare PPO/HMO/WC	$215.20

ER-TRIGGER POINT INJ

Facility

$1,434.65

Service Code	HCPCS 20552
Hospital Charge Code	5790060
Hospital Revenue Code	450
Min. Negotiated Rate	$215.20
Max. Negotiated Rate	$215.20
Rate for Payer: Qualcare PPO/HMO/WC	$215.20

ER-TRT HUMERUS FX CLOS-BI

Facility

$478.00

Hospital Charge Code	5790370
Hospital Revenue Code	450
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$71.70

ER-TRT HUMERUS FX CLOS-BI

Facility

$478.00

Hospital Charge Code	5790370
Hospital Revenue Code	450
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$143.40
Rate for Payer: Aetna Medicare Advantage	$143.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.89
Rate for Payer: Cigna Commercial	$239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.14
Rate for Payer: Qualcare PPO/HMO/WC	$71.70

ER-TRT WRIST BONE FX-BI

Facility

$492.00

Hospital Charge Code	5790455
Hospital Revenue Code	450
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

ER-TRT WRIST BONE FX-BI

Facility

$492.00

Hospital Charge Code	5790455
Hospital Revenue Code	450
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$147.60
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.96
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

ER TX ACROMIOCLAV DISL W/ MANI

Facility

$2,622.50

Service Code	HCPCS 23545
Hospital Charge Code	5700734
Hospital Revenue Code	450
Min. Negotiated Rate	$393.38
Max. Negotiated Rate	$393.38
Rate for Payer: Qualcare PPO/HMO/WC	$393.38

ER TX ACROMIOCLAV DISL W/ MANI

Facility

$2,622.50

Service Code	HCPCS 23545
Hospital Charge Code	5700734
Hospital Revenue Code	450
Min. Negotiated Rate	$136.88
Max. Negotiated Rate	$786.75
Rate for Payer: Aetna Commercial	$786.75
Rate for Payer: Aetna Medicare Advantage	$786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$668.74
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.93
Rate for Payer: Qualcare PPO/HMO/WC	$393.38

ER TX ACROMIOCLAV DISL W/O MAN

Facility

$906.60

Service Code	HCPCS 23540
Hospital Charge Code	5700733
Hospital Revenue Code	450
Min. Negotiated Rate	$135.99
Max. Negotiated Rate	$135.99
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER TX ACROMIOCLAV DISL W/O MAN

Facility

$906.60

Service Code	HCPCS 23540
Hospital Charge Code	5700733
Hospital Revenue Code	450
Min. Negotiated Rate	$72.45
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$271.98
Rate for Payer: Aetna Medicare Advantage	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.18
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	$231.18
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.86
Rate for Payer: Qualcare PPO/HMO/WC	$135.99

ER-TX ANKLE DISL CLOSE-BI

Facility

$4,500.00

Hospital Charge Code	5790625
Hospital Revenue Code	450
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

ER-TX ANKLE DISL CLOSE-BI

Facility

$4,500.00

Hospital Charge Code	5790625
Hospital Revenue Code	450
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

ER TX CARPAL FX W/O ANES EACH

Facility

$563.75

Service Code	HCPCS 25630
Hospital Charge Code	5700571
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER TX CARPAL FX W/O ANES EACH

Facility

$563.75

Service Code	HCPCS 25630
Hospital Charge Code	5700571
Hospital Revenue Code	450
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$169.12
Rate for Payer: Aetna Medicare Advantage	$169.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.76
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER-TX CARPO DISLO-BI

Facility

$466.00

Hospital Charge Code	5790495
Hospital Revenue Code	450
Min. Negotiated Rate	$69.90
Max. Negotiated Rate	$69.90
Rate for Payer: Qualcare PPO/HMO/WC	$69.90

ER-TX CARPO DISLO-BI

Facility

$466.00

Hospital Charge Code	5790495
Hospital Revenue Code	450
Min. Negotiated Rate	$60.58
Max. Negotiated Rate	$233.00
Rate for Payer: Aetna Commercial	$139.80
Rate for Payer: Aetna Medicare Advantage	$139.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.83
Rate for Payer: Cigna Commercial	$233.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.58
Rate for Payer: Qualcare PPO/HMO/WC	$69.90

ER-TX CARPO DISLOC EA-BI

Facility

$498.00

Hospital Charge Code	5790500
Hospital Revenue Code	450
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

ER-TX CARPO DISLOC EA-BI

Facility

$498.00

Hospital Charge Code	5790500
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

Know your out-of-pocket cost for care.

All Charges