Heights University Hospital

All Charges

Charge

Type

Setting

Price

OFFICE OP VISIT NEW - II

Facility

$477.85

Service Code	HCPCS 99202
Hospital Charge Code	85000825
Hospital Revenue Code	510
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$71.68
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

OF FOOT FRACTURE

Facility

$48,992.10

Service Code	HCPCS 28465
Hospital Charge Code	16000574
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$14,697.63
Rate for Payer: Aetna Medicare Advantage	$14,697.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,492.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,492.99
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	$12,492.99
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,368.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OF FOOT FRACTURE

Facility

$48,992.10

Service Code	HCPCS 28465
Hospital Charge Code	16000574
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OFFSET CONNECTOR 3MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687950
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.75
Max. Negotiated Rate	$6,132.50
Rate for Payer: Aetna Commercial	$3,679.50
Rate for Payer: Aetna Medicare Advantage	$3,679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,127.57
Rate for Payer: Cigna Commercial	$6,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75

OFFSET CONNECTOR 3MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687950
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.75
Max. Negotiated Rate	$2,968.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75

OFFSET CONNECTOR 5MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.75
Max. Negotiated Rate	$2,968.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75

OFFSET CONNECTOR 5MM

Facility

$12,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270687676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.75
Max. Negotiated Rate	$6,132.50
Rate for Payer: Aetna Commercial	$3,679.50
Rate for Payer: Aetna Medicare Advantage	$3,679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,127.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,453.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,127.57
Rate for Payer: Cigna Commercial	$6,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,968.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.75

OFFSET LAT TOPLOAD 30MM

Facility

$4,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270695326
Hospital Revenue Code	278
Min. Negotiated Rate	$678.75
Max. Negotiated Rate	$2,262.50
Rate for Payer: Aetna Commercial	$1,357.50
Rate for Payer: Aetna Medicare Advantage	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,153.88
Rate for Payer: Cigna Commercial	$2,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,095.05
Rate for Payer: Qualcare PPO/HMO/WC	$678.75

OFFSET LAT TOPLOAD 30MM

Facility

$4,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270695326
Hospital Revenue Code	278
Min. Negotiated Rate	$678.75
Max. Negotiated Rate	$1,095.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,095.05
Rate for Payer: Qualcare PPO/HMO/WC	$678.75

OFFSET TIBIAL TRAY 67MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270680591
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.50
Max. Negotiated Rate	$3,114.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50

OFFSET TIBIAL TRAY 67MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270680591
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.50
Max. Negotiated Rate	$6,435.00
Rate for Payer: Aetna Commercial	$3,861.00
Rate for Payer: Aetna Medicare Advantage	$3,861.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,281.85
Rate for Payer: Cigna Commercial	$6,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50

OFFSET TIBIAL TRAY 71MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270682263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.50
Max. Negotiated Rate	$6,435.00
Rate for Payer: Aetna Commercial	$3,861.00
Rate for Payer: Aetna Medicare Advantage	$3,861.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,281.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,281.85
Rate for Payer: Cigna Commercial	$6,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50

OFFSET TIBIAL TRAY 71MM

Facility

$12,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270682263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,930.50
Max. Negotiated Rate	$3,114.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,114.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,930.50

OFF VISIT EST PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84505030
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$133.80
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT EST PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84505030
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT EST PATIENT LEVEL3

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84505035
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OFF VISIT EST PATIENT LEVEL3

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84505035
Hospital Revenue Code	510
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$196.56
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.18
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OFF VISIT EST PATIENT LEVEL 4

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84505040
Hospital Revenue Code	510
Min. Negotiated Rate	$91.37
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT EST PATIENT LEVEL 4

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84505040
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT EST PATIENT LEVEL 5

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84505045
Hospital Revenue Code	510
Min. Negotiated Rate	$135.96
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$364.14
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.79
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OFF VISIT EST PATIENT LEVEL 5

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84505045
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OFF VISIT EST PATIENT LIVEL 1

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	84505025
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OFF VISIT EST PATIENT LIVEL 1

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	84505025
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$95.89
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OFF VISIT NEW PATIENT LEVEL 1

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84505001
Hospital Revenue Code	510
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OFF VISIT NEW PATIENT LEVEL 1

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84505001
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

Know your out-of-pocket cost for care.

All Charges