Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW I&REM FB SUBC TISS SIMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	83652005
Hospital Revenue Code	761
Min. Negotiated Rate	$91.25
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$231.90
Rate for Payer: Aetna Medicare Advantage	$231.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.12
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.49
Rate for Payer: Oxford Commercial	$386.50
Rate for Payer: Qualcare PPO/HMO/WC	$115.95
Rate for Payer: UnitedHealthcare Commercial	$386.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

RW I&REM FB SUB SUC TS SMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	87502105
Hospital Revenue Code	761
Min. Negotiated Rate	$91.25
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$231.90
Rate for Payer: Aetna Medicare Advantage	$231.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.12
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.49
Rate for Payer: Oxford Commercial	$386.50
Rate for Payer: Qualcare PPO/HMO/WC	$115.95
Rate for Payer: UnitedHealthcare Commercial	$386.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

RW I&REM FB SUB SUC TS SMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	87502105
Hospital Revenue Code	761
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$115.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.95

RW I&REM SUB TS COMPLEX

Facility

$1,490.00

Service Code	HCPCS 10120
Hospital Charge Code	87502110
Hospital Revenue Code	761
Min. Negotiated Rate	$91.25
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$447.00
Rate for Payer: Aetna Medicare Advantage	$447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.95
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.70
Rate for Payer: Oxford Commercial	$745.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.50
Rate for Payer: UnitedHealthcare Commercial	$745.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

RW I&REM SUB TS COMPLEX

Facility

$1,490.00

Service Code	HCPCS 10120
Hospital Charge Code	87502110
Hospital Revenue Code	761
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$223.50
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

RW MENACTRA

Facility

$463.50

Service Code	HCPCS 90734
Hospital Charge Code	87502858
Hospital Revenue Code	636
Min. Negotiated Rate	$69.53
Max. Negotiated Rate	$231.75
Rate for Payer: Aetna Commercial	$139.05
Rate for Payer: Aetna Medicare Advantage	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.19
Rate for Payer: Cigna Commercial	$231.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.53

RW MENACTRA

Facility

$463.50

Service Code	HCPCS 90734
Hospital Charge Code	87502858
Hospital Revenue Code	636
Min. Negotiated Rate	$69.53
Max. Negotiated Rate	$112.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.53

RW MENACTRA(MENINGOCOCCAL)VIAL

Facility

$208.00

Service Code	HCPCS 90734
Hospital Charge Code	84206370
Hospital Revenue Code	636
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

RW MENACTRA(MENINGOCOCCAL)VIAL

Facility

$208.00

Service Code	HCPCS 90734
Hospital Charge Code	84206370
Hospital Revenue Code	636
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$50.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

RW M-M-R II SDV

Facility

$139.00

Service Code	HCPCS 90710
Hospital Charge Code	84206375
Hospital Revenue Code	636
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

RW M-M-R II SDV

Facility

$139.00

Service Code	HCPCS 90710
Hospital Charge Code	84206375
Hospital Revenue Code	636
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$33.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

RW NAIL AVULSION-PART/COMP SIN

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	87502130
Hospital Revenue Code	761
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

RW NAIL AVULSION-PART/COMP SIN

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	87502130
Hospital Revenue Code	761
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$160.50
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
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	$136.43
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.55
Rate for Payer: Oxford Commercial	$267.50
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$267.50

RW NAIL AVULSION,PART/COMP SNG

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	84206055
Hospital Revenue Code	761
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$160.50
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
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	$136.43
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.55
Rate for Payer: Oxford Commercial	$267.50
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$267.50

RW NAIL AVULSION,PART/COMP SNG

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	84206055
Hospital Revenue Code	761
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

RW NAIL EXCISION-MATRIX PERMNT

Facility

$1,208.00

Service Code	HCPCS 11750
Hospital Charge Code	84206060
Hospital Revenue Code	761
Min. Negotiated Rate	$181.20
Max. Negotiated Rate	$181.20
Rate for Payer: Qualcare PPO/HMO/WC	$181.20

RW NAIL EXCISION-MATRIX PERMNT

Facility

$1,208.00

Service Code	HCPCS 11750
Hospital Charge Code	84206060
Hospital Revenue Code	761
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$362.40
Rate for Payer: Aetna Medicare Advantage	$362.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.04
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.04
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$181.20
Rate for Payer: UnitedHealthcare Commercial	$604.00

RW NEW PT - VISIT - COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84206330
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

RW NEW PT - VISIT - COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84206330
Hospital Revenue Code	510
Min. Negotiated Rate	$130.39
Max. Negotiated Rate	$300.90
Rate for Payer: Aetna Commercial	$300.90
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.39
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

RW NEW PT - VISIT - COMPREHENS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84206325
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

RW NEW PT - VISIT - COMPREHENS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84206325
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

RW NEW PT - VISIT - DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84206320
Hospital Revenue Code	510
Min. Negotiated Rate	$77.24
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	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

RW NEW PT - VISIT - DETAILED

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84206320
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

RW NEW PT - VISIT - EXPANDED

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	84206315
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

RW NEW PT - VISIT - EXPANDED

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	84206315
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

Know your out-of-pocket cost for care.

All Charges