Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXC FACE TUM DEEP 2+ CM

Facility

$20,625.50

Service Code	HCPCS 21016
Hospital Charge Code	16000797
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

EXC F/E/E/N/L MAL+MRG 0.6-1

Facility

$2,714.04

Service Code	HCPCS 11641
Hospital Charge Code	16000530
Hospital Revenue Code	360
Min. Negotiated Rate	$407.11
Max. Negotiated Rate	$407.11
Rate for Payer: Qualcare PPO/HMO/WC	$407.11

EXC F/E/E/N/L MAL+MRG 0.6-1

Facility

$2,714.04

Service Code	HCPCS 11641
Hospital Charge Code	16000530
Hospital Revenue Code	360
Min. Negotiated Rate	$352.83
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$814.21
Rate for Payer: Aetna Medicare Advantage	$814.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.08
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.83
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.11
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

EXC F/E/E/N/L MAL+MRG 1.1-2

Facility

$7,612.30

Service Code	HCPCS 11642
Hospital Charge Code	16000778
Hospital Revenue Code	360
Min. Negotiated Rate	$989.60
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$2,283.69
Rate for Payer: Aetna Medicare Advantage	$2,283.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,941.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,941.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,941.14
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.60
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

EXC F/E/E/N/L MAL+MRG 1.1-2

Facility

$7,612.30

Service Code	HCPCS 11642
Hospital Charge Code	16000778
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

EXC F/E/E/N/L MAL+MRG 2.1-3

Facility

$7,612.30

Service Code	HCPCS 11643
Hospital Charge Code	16000779
Hospital Revenue Code	360
Min. Negotiated Rate	$989.60
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,283.69
Rate for Payer: Aetna Medicare Advantage	$2,283.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,941.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,941.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,941.14
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.60
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

EXC F/E/E/N/L MAL+MRG 2.1-3

Facility

$7,612.30

Service Code	HCPCS 11643
Hospital Charge Code	16000779
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

EXC F/E/E/N/L MAL+MRG 3.1-4

Facility

$6,799.08

Service Code	HCPCS 11644
Hospital Charge Code	16000780
Hospital Revenue Code	360
Min. Negotiated Rate	$1,019.86
Max. Negotiated Rate	$1,019.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86

EXC F/E/E/N/L MAL+MRG 3.1-4

Facility

$6,799.08

Service Code	HCPCS 11644
Hospital Charge Code	16000780
Hospital Revenue Code	360
Min. Negotiated Rate	$883.88
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,039.72
Rate for Payer: Aetna Medicare Advantage	$2,039.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,733.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,733.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,733.77
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC FOOT CYST/GANGLION LT

Facility

$20,900.00

Service Code	HCPCS 28090
Hospital Charge Code	16000263
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,270.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$6,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,329.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,329.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,329.50
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,717.00
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,135.00
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC FOOT CYST/GANGLION LT

Facility

$20,900.00

Service Code	HCPCS 28090
Hospital Charge Code	16000263
Hospital Revenue Code	360
Min. Negotiated Rate	$3,135.00
Max. Negotiated Rate	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,135.00

EXC FOOT EXTNSR TENDON SHTH

Facility

$19,998.60

Service Code	HCPCS 28088
Hospital Charge Code	16000427
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$5,999.58
Rate for Payer: Aetna Medicare Advantage	$5,999.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,099.64
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,599.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC FOOT EXTNSR TENDON SHTH

Facility

$19,998.60

Service Code	HCPCS 28088
Hospital Charge Code	16000427
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

EXC FOOT FLEXOR TENDON SHTH RT

Facility

$19,998.60

Service Code	HCPCS 28086
Hospital Charge Code	16000512
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

EXC FOOT FLEXOR TENDON SHTH RT

Facility

$19,998.60

Service Code	HCPCS 28086
Hospital Charge Code	16000512
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$5,999.58
Rate for Payer: Aetna Medicare Advantage	$5,999.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,099.64
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,599.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC FOOT/TOE TUM DEEP <1.5CM

Facility

$13,615.20

Service Code	HCPCS 28045
Hospital Charge Code	16000569
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.28
Max. Negotiated Rate	$2,042.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.28

EXC FOOT/TOE TUM DEEP <1.5CM

Facility

$13,615.20

Service Code	HCPCS 28045
Hospital Charge Code	16000569
Hospital Revenue Code	360
Min. Negotiated Rate	$1,769.98
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$4,084.56
Rate for Payer: Aetna Medicare Advantage	$4,084.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,471.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,471.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,471.88
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,769.98
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.28
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC FOOT/TOE TUM DEP 1.5CM/>

Facility

$20,625.50

Service Code	HCPCS 28041
Hospital Charge Code	16000718
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$6,187.65
Rate for Payer: Aetna Medicare Advantage	$6,187.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,259.50
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,681.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC FOOT/TOE TUM DEP 1.5CM/>

Facility

$20,625.50

Service Code	HCPCS 28041
Hospital Charge Code	16000718
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

EXC FOOT/TOE TUM SC >1.5CM BL

Facility

$33,420.05

Service Code	HCPCS 28039
Hospital Charge Code	16000251
Hospital Revenue Code	360
Min. Negotiated Rate	$5,013.01
Max. Negotiated Rate	$5,013.01
Rate for Payer: Qualcare PPO/HMO/WC	$5,013.01

EXC FOOT/TOE TUM SC >1.5CM BL

Facility

$33,420.05

Service Code	HCPCS 28039
Hospital Charge Code	16000251
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,026.01
Rate for Payer: Aetna Commercial	$10,026.01
Rate for Payer: Aetna Medicare Advantage	$10,026.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,522.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,522.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,522.11
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,344.61
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,013.01
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC FOOT/TOE TUM SC <1.5CM LT

Facility

$16,853.95

Service Code	HCPCS 28043
Hospital Charge Code	16000277
Hospital Revenue Code	360
Min. Negotiated Rate	$2,528.09
Max. Negotiated Rate	$2,528.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,528.09

EXC FOOT/TOE TUM SC <1.5CM LT

Facility

$16,853.95

Service Code	HCPCS 28043
Hospital Charge Code	16000277
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,056.19
Rate for Payer: Aetna Commercial	$5,056.19
Rate for Payer: Aetna Medicare Advantage	$5,056.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,297.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,297.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,297.76
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.01
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,528.09
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC FOREARM LES SC 3 CM/>

Facility

$20,625.50

Service Code	HCPCS 25071
Hospital Charge Code	16000328
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

EXC FOREARM LES SC 3 CM/>

Facility

$20,625.50

Service Code	HCPCS 25071
Hospital Charge Code	16000328
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,187.65
Rate for Payer: Aetna Commercial	$6,187.65
Rate for Payer: Aetna Medicare Advantage	$6,187.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,259.50
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,681.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

Know your out-of-pocket cost for care.

All Charges