Heights University Hospital

All Charges

Charge

Type

Setting

Price

FOSPHENYTOIN 100 MG/2ML INJ

Facility

$192.83

Service Code	HCPCS Q2009
Hospital Charge Code	6017610
Hospital Revenue Code	636
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$46.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.66
Rate for Payer: Qualcare PPO/HMO/WC	$28.92

FOSPHENYTOIN 500 MG/10ML INJ

Facility

$578.41

Service Code	HCPCS Q2009
Hospital Charge Code	6017628
Hospital Revenue Code	636
Min. Negotiated Rate	$86.76
Max. Negotiated Rate	$139.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.76

FOSPHENYTOIN 500 MG/10ML INJ

Facility

$578.41

Service Code	HCPCS Q2009
Hospital Charge Code	6017628
Hospital Revenue Code	636
Min. Negotiated Rate	$86.76
Max. Negotiated Rate	$173.52
Rate for Payer: Aetna Commercial	$173.52
Rate for Payer: Aetna Medicare Advantage	$173.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.76

FP 1ST DEGREE INITIAL TREAT

Facility

$1,083.25

Service Code	HCPCS 16000
Hospital Charge Code	87502510
Hospital Revenue Code	761
Min. Negotiated Rate	$162.49
Max. Negotiated Rate	$162.49
Rate for Payer: Qualcare PPO/HMO/WC	$162.49

FP 1ST DEGREE INITIAL TREAT

Facility

$1,083.25

Service Code	HCPCS 16000
Hospital Charge Code	87502510
Hospital Revenue Code	761
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$554.01
Rate for Payer: Aetna Better Health Medicaid	$543.15
Rate for Payer: Aetna Commercial	$324.98
Rate for Payer: Aetna Medicare Advantage	$324.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.23
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.82
Rate for Payer: Oxford Commercial	$541.62
Rate for Payer: Qualcare PPO/HMO/WC	$162.49
Rate for Payer: UnitedHealthcare Commercial	$541.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$554.01

FP ARTHROCENTESIS INTER JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	87502535
Hospital Revenue Code	761
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$27.91
Rate for Payer: Qualcare PPO/HMO/WC	$27.91

FP ARTHROCENTESIS INTER JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	87502535
Hospital Revenue Code	761
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$55.81
Rate for Payer: Aetna Medicare Advantage	$55.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.44
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.19
Rate for Payer: Oxford Commercial	$93.02
Rate for Payer: Qualcare PPO/HMO/WC	$27.91
Rate for Payer: UnitedHealthcare Commercial	$93.02

FP ARTHROCENTESIS INTER. JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	83652095
Hospital Revenue Code	761
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$27.91
Rate for Payer: Qualcare PPO/HMO/WC	$27.91

FP ARTHROCENTESIS INTER. JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	83652095
Hospital Revenue Code	761
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$55.81
Rate for Payer: Aetna Medicare Advantage	$55.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.44
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.19
Rate for Payer: Oxford Commercial	$93.02
Rate for Payer: Qualcare PPO/HMO/WC	$27.91
Rate for Payer: UnitedHealthcare Commercial	$93.02

FP ARTHROCENTESIS SM JOINT

Facility

$175.91

Service Code	HCPCS 20600
Hospital Charge Code	87502540
Hospital Revenue Code	761
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$26.39
Rate for Payer: Qualcare PPO/HMO/WC	$26.39

FP ARTHROCENTESIS SM JOINT

Facility

$175.91

Service Code	HCPCS 20600
Hospital Charge Code	87502540
Hospital Revenue Code	761
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$52.77
Rate for Payer: Aetna Medicare Advantage	$52.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.86
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.87
Rate for Payer: Oxford Commercial	$87.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.39
Rate for Payer: UnitedHealthcare Commercial	$87.95

FP AUDIOMETRY

Facility

$101.70

Service Code	HCPCS 92552
Hospital Charge Code	87502715
Hospital Revenue Code	471
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$15.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.26

FP AUDIOMETRY

Facility

$101.70

Service Code	HCPCS 92552
Hospital Charge Code	87502715
Hospital Revenue Code	471
Min. Negotiated Rate	$13.22
Max. Negotiated Rate	$1,180.00
Rate for Payer: Aetna Commercial	$30.51
Rate for Payer: Aetna Medicare Advantage	$30.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.93
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.26
Rate for Payer: UnitedHealthcare Commercial	$1,180.00

FP AVULSION & ADDTL NAIL PL

Facility

$495.25

Service Code	HCPCS 11732
Hospital Charge Code	87502485
Hospital Revenue Code	761
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$247.62
Rate for Payer: Aetna Commercial	$148.57
Rate for Payer: Aetna Medicare Advantage	$148.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.29
Rate for Payer: Cigna Commercial	$16.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.38
Rate for Payer: Oxford Commercial	$247.62
Rate for Payer: Qualcare PPO/HMO/WC	$74.29
Rate for Payer: UnitedHealthcare Commercial	$247.62

FP AVULSION & ADDTL NAIL PL

Facility

$495.25

Service Code	HCPCS 11732
Hospital Charge Code	87502485
Hospital Revenue Code	761
Min. Negotiated Rate	$74.29
Max. Negotiated Rate	$74.29
Rate for Payer: Qualcare PPO/HMO/WC	$74.29

FP AVULSION&ADDTN'L NAIL PL

Facility

$372.00

Service Code	HCPCS 11732
Hospital Charge Code	83652053
Hospital Revenue Code	761
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$16.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

FP AVULSION&ADDTN'L NAIL PL

Facility

$372.00

Service Code	HCPCS 11732
Hospital Charge Code	83652053
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

FP AVULSION OF NAIL PL

Facility

$372.00

Service Code	HCPCS 11730
Hospital Charge Code	87502480
Hospital Revenue Code	761
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

FP AVULSION OF NAIL PL

Facility

$372.00

Service Code	HCPCS 11730
Hospital Charge Code	87502480
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

FP BX SKIN & ADDTL LESION

Facility

$344.17

Service Code	HCPCS 11101
Hospital Charge Code	87502460
Hospital Revenue Code	761
Min. Negotiated Rate	$51.63
Max. Negotiated Rate	$51.63
Rate for Payer: Qualcare PPO/HMO/WC	$51.63

FP BX SKIN & ADDTL LESION

Facility

$344.17

Service Code	HCPCS 11101
Hospital Charge Code	87502460
Hospital Revenue Code	761
Min. Negotiated Rate	$44.74
Max. Negotiated Rate	$172.09
Rate for Payer: Aetna Commercial	$103.25
Rate for Payer: Aetna Medicare Advantage	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.76
Rate for Payer: Cigna Commercial	$172.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.74
Rate for Payer: Oxford Commercial	$172.09
Rate for Payer: Qualcare PPO/HMO/WC	$51.63
Rate for Payer: UnitedHealthcare Commercial	$172.09

FP BX SKIN & ADDTN'L LESION

Facility

$344.17

Service Code	HCPCS 11101
Hospital Charge Code	83652029
Hospital Revenue Code	761
Min. Negotiated Rate	$51.63
Max. Negotiated Rate	$51.63
Rate for Payer: Qualcare PPO/HMO/WC	$51.63

FP BX SKIN & ADDTN'L LESION

Facility

$344.17

Service Code	HCPCS 11101
Hospital Charge Code	83652029
Hospital Revenue Code	761
Min. Negotiated Rate	$44.74
Max. Negotiated Rate	$172.09
Rate for Payer: Aetna Commercial	$103.25
Rate for Payer: Aetna Medicare Advantage	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.76
Rate for Payer: Cigna Commercial	$172.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.74
Rate for Payer: Oxford Commercial	$172.09
Rate for Payer: Qualcare PPO/HMO/WC	$51.63
Rate for Payer: UnitedHealthcare Commercial	$172.09

FP CERUMEN REMOVAL

Facility

$167.24

Service Code	HCPCS 69210
Hospital Charge Code	87502530
Hospital Revenue Code	761
Min. Negotiated Rate	$21.74
Max. Negotiated Rate	$197.37
Rate for Payer: Aetna Better Health Medicaid	$193.50
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.65
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.74
Rate for Payer: Oxford Commercial	$83.62
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$83.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37

FP CERUMEN REMOVAL

Facility

$167.24

Service Code	HCPCS 69210
Hospital Charge Code	87502530
Hospital Revenue Code	761
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

Know your out-of-pocket cost for care.

All Charges