Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84504070
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	87506001
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	87506001
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84504070
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

SUBTALAR ARTHRO W/DEB

Facility

$25,603.80

Service Code	HCPCS 29906
Hospital Charge Code	16000922
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$7,681.14
Rate for Payer: Aetna Medicare Advantage	$7,681.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,528.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,528.97
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	$6,528.97
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.49
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

SUBTALAR ARTHRO W/DEB

Facility

$25,603.80

Service Code	HCPCS 29906
Hospital Charge Code	16000922
Hospital Revenue Code	360
Min. Negotiated Rate	$3,840.57
Max. Negotiated Rate	$3,840.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57

SUBTALAR IMPLANT STA-PEG MED

Facility

$7,290.00

Hospital Charge Code	270666785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

SUBTALAR IMPLANT STA-PEG MED

Facility

$7,290.00

Hospital Charge Code	270666785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$3,645.00
Rate for Payer: Aetna Commercial	$2,187.00
Rate for Payer: Aetna Medicare Advantage	$2,187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,858.95
Rate for Payer: Cigna Commercial	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

SUBTALAR MBA 10MM

Facility

$5,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270690965
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SUBTALAR MBA 10MM

Facility

$5,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270690965
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SUBTALAR MBA 8MM IMPLANT

Facility

$12,495.00

Hospital Charge Code	270667235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,874.25
Max. Negotiated Rate	$6,247.50
Rate for Payer: Aetna Commercial	$3,748.50
Rate for Payer: Aetna Medicare Advantage	$3,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,186.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,186.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,186.22
Rate for Payer: Cigna Commercial	$6,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,874.25

SUBTALAR MBA 8MM IMPLANT

Facility

$12,495.00

Hospital Charge Code	270667235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,874.25
Max. Negotiated Rate	$3,023.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,874.25

SUBTALAR PITSTOP 12.7X10MM

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692058
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

SUBTALAR PITSTOP 12.7X10MM

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692058
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$5,242.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58180
Hospital Charge Code	1600000563
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.82
Max. Negotiated Rate	$2,271.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58150
Hospital Charge Code	1600000313
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.82
Max. Negotiated Rate	$2,271.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58180
Hospital Charge Code	1600000563
Hospital Revenue Code	360
Min. Negotiated Rate	$943.67
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,543.64
Rate for Payer: Aetna Medicare Advantage	$4,543.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,862.09
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	$3,862.09
Rate for Payer: Cigna Commercial	$943.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,968.91
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58150
Hospital Charge Code	1600000313
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.37
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,543.64
Rate for Payer: Aetna Medicare Advantage	$4,543.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,862.09
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	$3,862.09
Rate for Payer: Cigna Commercial	$1,017.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,968.91
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

SUCCINYLCHOLINE

Facility

$47.35

Hospital Charge Code	270656764
Hospital Revenue Code	270
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.16
Rate for Payer: Oxford Commercial	$23.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$23.68

SUCCINYLCHOLINE

Facility

$47.35

Hospital Charge Code	270656764
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$154.23

Service Code	HCPCS J0330
Hospital Charge Code	6007538
Hospital Revenue Code	636
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$46.27
Rate for Payer: Aetna Medicare Advantage	$46.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.33
Rate for Payer: Cigna Commercial	$77.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.13

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$154.23

Service Code	HCPCS J0330
Hospital Charge Code	6007538
Hospital Revenue Code	636
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$37.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.13

SUCCINYLCHOLINE CHLR FLO-PACK

Facility

$4.50

Hospital Charge Code	6013247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

SUCCINYLCHOLINE CHLR FLO-PACK

Facility

$4.50

Hospital Charge Code	6013247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

SUCCINYLCHOLINE CHLR VIAL

Facility

$4.50

Hospital Charge Code	6013254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

Know your out-of-pocket cost for care.

All Charges