Heights University Hospital

All Charges

Charge

Type

Setting

Price

OPEN TX FEM W PLATE/SCREWS

Facility

$20,528.74

Service Code	HCPCS 27507
Hospital Charge Code	1600000568
Hospital Revenue Code	360
Min. Negotiated Rate	$3,079.31
Max. Negotiated Rate	$3,079.31
Rate for Payer: Qualcare PPO/HMO/WC	$3,079.31

OPEN TX FRAC DISTAL TIBIA ONLY

Facility

$63,943.60

Service Code	HCPCS 27827
Hospital Charge Code	160000235
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OPEN TX FRAC DISTAL TIBIA ONLY

Facility

$63,943.60

Service Code	HCPCS 27827
Hospital Charge Code	160000235
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$19,183.08
Rate for Payer: Aetna Medicare Advantage	$19,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,305.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,305.62
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	$16,305.62
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,312.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN TX OF INT JT DISLOCATION

Facility

$17,096.75

Service Code	HCPCS 28675
Hospital Charge Code	323028675
Hospital Revenue Code	450
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$5,129.02
Rate for Payer: Aetna Medicare Advantage	$5,129.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.67
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,222.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.51

OPEN TX OF INT JT DISLOCATION

Facility

$17,096.75

Service Code	HCPCS 28675
Hospital Charge Code	323028675
Hospital Revenue Code	450
Min. Negotiated Rate	$2,564.51
Max. Negotiated Rate	$2,564.51
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.51

OPEN TX PATELLAR DISOCATION

Facility

$28,225.00

Service Code	HCPCS 27566
Hospital Charge Code	16000888
Hospital Revenue Code	360
Min. Negotiated Rate	$4,233.75
Max. Negotiated Rate	$4,233.75
Rate for Payer: Qualcare PPO/HMO/WC	$4,233.75

OPEN TX PATELLAR DISOCATION

Facility

$28,225.00

Service Code	HCPCS 27566
Hospital Charge Code	16000888
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$8,467.50
Rate for Payer: Aetna Medicare Advantage	$8,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,197.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,197.38
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	$7,197.38
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,669.25
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,233.75
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OPEN TX RADIAL SHAFT FRACTURE

Facility

$48,992.10

Service Code	HCPCS 25515
Hospital Charge Code	16000551
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

OPEN TX RADIAL SHAFT FRACTURE

Facility

$48,992.10

Service Code	HCPCS 25515
Hospital Charge Code	16000551
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

OPEN TX SEPTAL FRACTURE W/WO S

Facility

$13,687.25

Service Code	HCPCS 21330
Hospital Charge Code	323021336
Hospital Revenue Code	450
Min. Negotiated Rate	$2,053.09
Max. Negotiated Rate	$2,053.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,053.09

OPEN TX SEPTAL FRACTURE W/WO S

Facility

$13,687.25

Service Code	HCPCS 21330
Hospital Charge Code	323021336
Hospital Revenue Code	450
Min. Negotiated Rate	$306.21
Max. Negotiated Rate	$14,097.46
Rate for Payer: Aetna Commercial	$4,106.18
Rate for Payer: Aetna Medicare Advantage	$4,106.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,490.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,490.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,490.25
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,779.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,053.09

OP ESTABLISHED PT VISIT LEV 1

Facility

$129.00

Service Code	HCPCS 99211
Hospital Charge Code	3401033
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna Commercial	$38.70
Rate for Payer: Aetna Medicare Advantage	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.90
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.77
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

OP ESTABLISHED PT VISIT LEV 1

Facility

$129.00

Service Code	HCPCS 99211
Hospital Charge Code	3401033
Hospital Revenue Code	510
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

OP ESTABLISHED PT VISIT LEV 2

Facility

$192.00

Service Code	HCPCS 99212
Hospital Charge Code	3401034
Hospital Revenue Code	510
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: Aetna Medicare Advantage	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.96
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.96
Rate for Payer: Qualcare PPO/HMO/WC	$28.80

OP ESTABLISHED PT VISIT LEV 2

Facility

$192.00

Service Code	HCPCS 99212
Hospital Charge Code	3401034
Hospital Revenue Code	510
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$28.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.80

OP ESTABLISHED PT VISIT LEV 3

Facility

$257.00

Service Code	HCPCS 99213
Hospital Charge Code	3401035
Hospital Revenue Code	510
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

OP ESTABLISHED PT VISIT LEV 3

Facility

$257.00

Service Code	HCPCS 99213
Hospital Charge Code	3401035
Hospital Revenue Code	510
Min. Negotiated Rate	$33.41
Max. Negotiated Rate	$77.10
Rate for Payer: Aetna Commercial	$77.10
Rate for Payer: Aetna Medicare Advantage	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.53
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.41
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

OP ESTABLISHED PT VISIT LEV 4

Facility

$320.00

Service Code	HCPCS 99214
Hospital Charge Code	3401036
Hospital Revenue Code	510
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

OP ESTABLISHED PT VISIT LEV 4

Facility

$320.00

Service Code	HCPCS 99214
Hospital Charge Code	3401036
Hospital Revenue Code	510
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$96.00
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

OP ESTABLISHED PT VISIT LEV 5

Facility

$384.00

Service Code	HCPCS 99215
Hospital Charge Code	3401037
Hospital Revenue Code	510
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

OP ESTABLISHED PT VISIT LEV 5

Facility

$384.00

Service Code	HCPCS 99215
Hospital Charge Code	3401037
Hospital Revenue Code	510
Min. Negotiated Rate	$49.92
Max. Negotiated Rate	$135.96
Rate for Payer: Aetna Commercial	$115.20
Rate for Payer: Aetna Medicare Advantage	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.92
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.92
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

OPHTHALGAN OPHTH/7.5ML

Facility

$95.00

Hospital Charge Code	60633576
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

OPHTHALGAN OPHTH/7.5ML

Facility

$95.00

Hospital Charge Code	60633576
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

OPHTHALMIC IRRIGATION SOLN

Facility

$46.45

Hospital Charge Code	60628803
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

OPHTHALMIC IRRIGATION SOLN

Facility

$46.45

Hospital Charge Code	60628803
Hospital Revenue Code	250
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$13.94
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$23.23

Know your out-of-pocket cost for care.

All Charges