Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC ACELL XENOGRAFT 1ST 100 ADD

Facility

$1,183.95

Hospital Charge Code	9800255
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC ACELL XENOGRAFT 1ST 100 ADD

Facility

$1,183.95

Hospital Charge Code	9800255
Hospital Revenue Code	510
Min. Negotiated Rate	$153.91
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC ACTICOAT SILVER WOUND DRESS

Facility

$226.00

Service Code	HCPCS A9270
Hospital Charge Code	9808160
Hospital Revenue Code	272
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

WC ACTICOAT SILVER WOUND DRESS

Facility

$226.00

Service Code	HCPCS A9270
Hospital Charge Code	9808160
Hospital Revenue Code	272
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$67.80
Rate for Payer: Aetna Medicare Advantage	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.63
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.38
Rate for Payer: Oxford Commercial	$113.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$113.00

WC ALLEVYN AG ADHESIVE 5 X %

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$13.84
Rate for Payer: Cigna Medicare Advantage	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

WC ALLEVYN AG ADHESIVE 5 X %

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC ALLEVYN DRSNG >48SQ IN W/O

Facility

$24.00

Service Code	HCPCS A6211
Hospital Charge Code	9808130
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$41.86
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$41.86
Rate for Payer: Cigna Medicare Advantage	$25.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$12.00

WC ALLEVYN DRSNG >48SQ IN W/O

Facility

$24.00

Service Code	HCPCS A6211
Hospital Charge Code	9808130
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

WC ALLEVYN HEEL DRESSING

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808125
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

WC ALLEVYN HEEL DRESSING

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808125
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$28.40
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$28.40
Rate for Payer: Cigna Medicare Advantage	$17.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

WC ALLEVYN ISLAND 4X4

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808110
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$10.65
Rate for Payer: Cigna Medicare Advantage	$6.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

WC ALLEVYN ISLAND 4X4

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808110
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC ALLEYN AG NON ADHESIVE 4 X

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808115
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$10.65
Rate for Payer: Cigna Medicare Advantage	$6.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

WC ALLEYN AG NON ADHESIVE 4 X

Facility

$33.00

Service Code	HCPCS A6209
Hospital Charge Code	9808115
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC ALLOGRAFT FACE/FEET INI 100

Facility

$1,898.15

Hospital Charge Code	9800425
Hospital Revenue Code	510
Min. Negotiated Rate	$284.72
Max. Negotiated Rate	$284.72
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT FACE/FEET INI 100

Facility

$1,898.15

Hospital Charge Code	9800425
Hospital Revenue Code	510
Min. Negotiated Rate	$246.76
Max. Negotiated Rate	$949.08
Rate for Payer: Aetna Commercial	$569.45
Rate for Payer: Aetna Medicare Advantage	$569.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.03
Rate for Payer: Cigna Commercial	$949.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT TR/AR/L INI 100CM

Facility

$1,898.15

Hospital Charge Code	9800420
Hospital Revenue Code	510
Min. Negotiated Rate	$284.72
Max. Negotiated Rate	$284.72
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT TR/AR/L INI 100CM

Facility

$1,898.15

Hospital Charge Code	9800420
Hospital Revenue Code	510
Min. Negotiated Rate	$246.76
Max. Negotiated Rate	$949.08
Rate for Payer: Aetna Commercial	$569.45
Rate for Payer: Aetna Medicare Advantage	$569.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.03
Rate for Payer: Cigna Commercial	$949.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC AMP TOE/METATARSOPHALANGEAL

Facility

$4,822.60

Service Code	HCPCS 28820
Hospital Charge Code	9800145
Hospital Revenue Code	510
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$723.39
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMP TOE/METATARSOPHALANGEAL

Facility

$4,822.60

Service Code	HCPCS 28820
Hospital Charge Code	9800145
Hospital Revenue Code	510
Min. Negotiated Rate	$101.43
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$1,446.78
Rate for Payer: Aetna Medicare Advantage	$1,446.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,229.76
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$626.94
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMPUTATION OF TOE - PARTIAL

Facility

$4,822.60

Service Code	HCPCS 28825
Hospital Charge Code	9800150
Hospital Revenue Code	510
Min. Negotiated Rate	$101.43
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$1,446.78
Rate for Payer: Aetna Medicare Advantage	$1,446.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,229.76
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$626.94
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMPUTATION OF TOE - PARTIAL

Facility

$4,822.60

Service Code	HCPCS 28825
Hospital Charge Code	9800150
Hospital Revenue Code	510
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$723.39
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMPUTATION SGL TOE/METATSAL

Facility

$4,822.60

Service Code	HCPCS 28810
Hospital Charge Code	9800140
Hospital Revenue Code	510
Min. Negotiated Rate	$219.47
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$1,446.78
Rate for Payer: Aetna Medicare Advantage	$1,446.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,229.76
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$626.94
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC AMPUTATION SGL TOE/METATSAL

Facility

$4,822.60

Service Code	HCPCS 28810
Hospital Charge Code	9800140
Hospital Revenue Code	510
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$723.39
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

WC ANKLE STRAPPING

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808055
Hospital Revenue Code	361
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$140.62
Rate for Payer: Aetna Medicare Advantage	$140.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.53
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	$119.53
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges