Heights University Hospital

All Charges

Charge

Type

Setting

Price

US NI LO EXT ANKLE BRAC IND

Facility

$17,200.00

Service Code	HCPCS 93922
Hospital Charge Code	405393922
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ANKLE BRAC IND

Facility

$17,200.00

Service Code	HCPCS 93922
Hospital Charge Code	405393922
Hospital Revenue Code	921
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI LO EXT ANKLE BRAC IND

Facility

$17,200.00

Service Code	HCPCS 93922
Hospital Charge Code	2101100
Hospital Revenue Code	921
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI LO EXT ANKLE BRAC IND

Facility

$17,200.00

Service Code	HCPCS 93922
Hospital Charge Code	2101100
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101098
Hospital Revenue Code	921
Min. Negotiated Rate	$315.10
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI LO EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101098
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ART MULTI UNI LT

Facility

$17,200.00

Service Code	HCPCS 9392352LT
Hospital Charge Code	2101102
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ART MULTI UNI LT

Facility

$17,200.00

Service Code	HCPCS 9392352LT
Hospital Charge Code	2101102
Hospital Revenue Code	921
Min. Negotiated Rate	$2,236.00
Max. Negotiated Rate	$8,600.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$8,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI LO EXT ART MULTI UNI RT

Facility

$17,200.00

Service Code	HCPCS 9392352RT
Hospital Charge Code	2101101
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ART MULTI UNI RT

Facility

$17,200.00

Service Code	HCPCS 9392352RT
Hospital Charge Code	2101101
Hospital Revenue Code	921
Min. Negotiated Rate	$2,236.00
Max. Negotiated Rate	$8,600.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$8,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI LO EXT REST POST TREAD

Facility

$5,100.00

Service Code	HCPCS 93924
Hospital Charge Code	2101094
Hospital Revenue Code	920
Min. Negotiated Rate	$377.20
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$377.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

US NI LO EXT REST POST TREAD

Facility

$5,100.00

Service Code	HCPCS 93924
Hospital Charge Code	2101094
Hospital Revenue Code	920
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

US NI UP EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101096
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI UP EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101096
Hospital Revenue Code	921
Min. Negotiated Rate	$315.10
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI UP EXT COLD SENSI

Facility

$1,440.90

Service Code	HCPCS 93923
Hospital Charge Code	2101092
Hospital Revenue Code	921
Min. Negotiated Rate	$216.13
Max. Negotiated Rate	$216.13
Rate for Payer: Qualcare PPO/HMO/WC	$216.13

US NI UP EXT COLD SENSI

Facility

$1,440.90

Service Code	HCPCS 93923
Hospital Charge Code	2101092
Hospital Revenue Code	921
Min. Negotiated Rate	$187.32
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$432.27
Rate for Payer: Aetna Medicare Advantage	$432.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$367.43
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.32
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$216.13
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI UP EXT THOR OUTLET

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101090
Hospital Revenue Code	921
Min. Negotiated Rate	$315.10
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NI UP EXT THOR OUTLET

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101090
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NONINVAS PHYS VEN EXTM BILA

Facility

$1,079.25

Service Code	HCPCS 93965
Hospital Charge Code	2100758
Hospital Revenue Code	921
Min. Negotiated Rate	$140.30
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$323.77
Rate for Payer: Aetna Medicare Advantage	$323.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.21
Rate for Payer: Cigna Commercial	$539.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.30
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.89
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US NONINVAS PHYS VEN EXTM BILA

Facility

$1,079.25

Service Code	HCPCS 93965
Hospital Charge Code	2100758
Hospital Revenue Code	921
Min. Negotiated Rate	$161.89
Max. Negotiated Rate	$161.89
Rate for Payer: Qualcare PPO/HMO/WC	$161.89

US-OB<14 WEEKS ADDITNL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	2008030
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

US-OB<14 WEEKS ADDITNL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	2008030
Hospital Revenue Code	402
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$335.10
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.83
Rate for Payer: Cigna Commercial	$67.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US-OB<14 WEEKS SINGLE FETUS-EA

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	2307015
Hospital Revenue Code	402
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$469.14
Rate for Payer: Aetna Medicare Advantage	$469.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.77
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.29
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US-OB<14 WEEKS SINGLE FETUS-EA

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	2307015
Hospital Revenue Code	402
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

US OB >/=14 WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	412376810
Hospital Revenue Code	402
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

Know your out-of-pocket cost for care.

All Charges