Heights University Hospital

All Charges

Charge

Type

Setting

Price

AMP NUCLEID ACID,EACH ADDITNL

Facility

$118.69

Service Code	HCPCS 8390191
Hospital Charge Code	38472805
Hospital Revenue Code	301
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

AMPRENAVIR 150 MG CAP

Facility

$1.95

Hospital Charge Code	60629150
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

AMPRENAVIR 150 MG CAP

Facility

$1.95

Hospital Charge Code	60629150
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

AMPUTAION OF THE KNEE

Facility

$19,503.55

Service Code	HCPCS 27599
Hospital Charge Code	16000478
Hospital Revenue Code	360
Min. Negotiated Rate	$2,925.53
Max. Negotiated Rate	$2,925.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.53

AMPUTAION OF THE KNEE

Facility

$19,503.55

Service Code	HCPCS 27599
Hospital Charge Code	16000478
Hospital Revenue Code	360
Min. Negotiated Rate	$587.42
Max. Negotiated Rate	$5,851.06
Rate for Payer: Aetna Commercial	$5,851.06
Rate for Payer: Aetna Medicare Advantage	$5,851.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,973.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,973.41
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	$4,973.41
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,535.46
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.53
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

AMPUTATE FOOT,TRANSMETATARSAL

Facility

$19,998.60

Service Code	HCPCS 28805
Hospital Charge Code	1600000340
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

AMPUTATE FOOT,TRANSMETATARSAL

Facility

$19,998.60

Service Code	HCPCS 28805
Hospital Charge Code	16000727
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

AMPUTATE FOOT,TRANSMETATARSAL

Facility

$19,998.60

Service Code	HCPCS 28805
Hospital Charge Code	16000727
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

AMPUTATE FOOT,TRANSMETATARSAL

Facility

$19,998.60

Service Code	HCPCS 28805
Hospital Charge Code	1600000340
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

AMPUTATELEG THRU TIBIA +FIBULA

Facility

$10,368.60

Service Code	HCPCS 27880
Hospital Charge Code	160000211
Hospital Revenue Code	360
Min. Negotiated Rate	$1,555.29
Max. Negotiated Rate	$1,555.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,555.29

AMPUTATELEG THRU TIBIA +FIBULA

Facility

$10,368.60

Service Code	HCPCS 27880
Hospital Charge Code	160000211
Hospital Revenue Code	360
Min. Negotiated Rate	$1,347.92
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$3,110.58
Rate for Payer: Aetna Medicare Advantage	$3,110.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,643.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,643.99
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	$2,643.99
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,347.92
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,555.29
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

AMPUTATE LOWER LEG AT KNEE

Facility

$7,443.40

Service Code	HCPCS 27598
Hospital Charge Code	1600000684
Hospital Revenue Code	360
Min. Negotiated Rate	$967.64
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$2,233.02
Rate for Payer: Aetna Medicare Advantage	$2,233.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,898.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,898.07
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	$1,898.07
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$967.64
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.51
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

AMPUTATE LOWER LEG AT KNEE

Facility

$7,443.40

Service Code	HCPCS 27598
Hospital Charge Code	1600000684
Hospital Revenue Code	360
Min. Negotiated Rate	$1,116.51
Max. Negotiated Rate	$1,116.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.51

AMPUTATE THIGH-FEMUR ANY LEVEL

Facility

$10,492.75

Service Code	HCPCS 27590
Hospital Charge Code	1600000413
Hospital Revenue Code	360
Min. Negotiated Rate	$1,364.06
Max. Negotiated Rate	$10,997.00
Rate for Payer: Aetna Commercial	$3,147.82
Rate for Payer: Aetna Medicare Advantage	$3,147.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,675.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,675.65
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	$2,675.65
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,364.06
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,573.91
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

AMPUTATE THIGH-FEMUR ANY LEVEL

Facility

$10,492.75

Service Code	HCPCS 27590
Hospital Charge Code	1600000413
Hospital Revenue Code	360
Min. Negotiated Rate	$1,573.91
Max. Negotiated Rate	$1,573.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,573.91

AMPUTATE THIGH- FEMUR OP CIRCU

Facility

$6,231.22

Service Code	HCPCS 27592
Hospital Charge Code	1600000418
Hospital Revenue Code	360
Min. Negotiated Rate	$810.06
Max. Negotiated Rate	$10,997.00
Rate for Payer: Aetna Commercial	$1,869.37
Rate for Payer: Aetna Medicare Advantage	$1,869.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,588.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,588.96
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	$1,588.96
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.06
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$934.68
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

AMPUTATE THIGH- FEMUR OP CIRCU

Facility

$6,231.22

Service Code	HCPCS 27592
Hospital Charge Code	1600000418
Hospital Revenue Code	360
Min. Negotiated Rate	$934.68
Max. Negotiated Rate	$934.68
Rate for Payer: Qualcare PPO/HMO/WC	$934.68

AMPUTATE TOE,IP JOINT-T6

Facility

$19,998.60

Service Code	HCPCS 28825
Hospital Charge Code	16000295
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

AMPUTATE TOE,IP JOINT-T6

Facility

$19,998.60

Service Code	HCPCS 28825
Hospital Charge Code	16000295
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

AMPUTATE TOE,MTP JOINT

Facility

$19,998.60

Service Code	HCPCS 28820
Hospital Charge Code	16000306
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

AMPUTATE TOE,MTP JOINT

Facility

$19,998.60

Service Code	HCPCS 28820
Hospital Charge Code	16000306
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

AMPUTAT FING/TH SGL,W DIR CL

Facility

$14,854.00

Service Code	HCPCS 26951
Hospital Charge Code	16000621
Hospital Revenue Code	360
Min. Negotiated Rate	$2,228.10
Max. Negotiated Rate	$2,228.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,228.10

AMPUTAT FING/TH SGL,W DIR CL

Facility

$14,854.00

Service Code	HCPCS 26951
Hospital Charge Code	16000621
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$4,456.20
Rate for Payer: Aetna Medicare Advantage	$4,456.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.77
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	$3,787.77
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,228.10
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

AMPUTATION FINGER/THUMB

Facility

$15,508.45

Service Code	HCPCS 26951
Hospital Charge Code	323026951
Hospital Revenue Code	450
Min. Negotiated Rate	$147.31
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$4,652.53
Rate for Payer: Aetna Medicare Advantage	$4,652.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,954.65
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	$3,954.65
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,016.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,326.27

AMPUTATION FINGER/THUMB

Facility

$15,508.45

Service Code	HCPCS 26951
Hospital Charge Code	323026951
Hospital Revenue Code	450
Min. Negotiated Rate	$2,326.27
Max. Negotiated Rate	$2,326.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,326.27

Know your out-of-pocket cost for care.

All Charges