Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC ANKLE STRAPPING

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808055
Hospital Revenue Code	361
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

WC ANTEPARTUM 4-6 VIS

Facility

$270.00

Service Code	HCPCS 59425
Hospital Charge Code	83652225
Hospital Revenue Code	514
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WC ANTEPARTUM 4-6 VIS

Facility

$270.00

Service Code	HCPCS 59425
Hospital Charge Code	83652225
Hospital Revenue Code	514
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$422.36
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$422.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WC APLIGRAF - PER SQ CM

Facility

$162.95

Service Code	HCPCS Q4101
Hospital Charge Code	9800245
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Medicare Advantage	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.55
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAF - PER SQ CM

Facility

$162.95

Service Code	HCPCS Q4101
Hospital Charge Code	9800245
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAF - PER SQ CM JW

Facility

$162.95

Service Code	HCPCS Q4101JW
Hospital Charge Code	9800245W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$81.47
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Medicare Advantage	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.55
Rate for Payer: Cigna Commercial	$81.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAF - PER SQ CM JW

Facility

$162.95

Service Code	HCPCS Q4101JW
Hospital Charge Code	9800245W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAF PER SQ CM - WASTE

Facility

$162.95

Hospital Charge Code	9800245WM
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAF PER SQ CM - WASTE

Facility

$162.95

Hospital Charge Code	9800245WM
Hospital Revenue Code	636
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$81.47
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Medicare Advantage	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.55
Rate for Payer: Cigna Commercial	$81.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.44

WC APLIGRAFT TISS ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808200
Hospital Revenue Code	519
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808200
Hospital Revenue Code	519
Min. Negotiated Rate	$168.09
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$387.90
Rate for Payer: Aetna Medicare Advantage	$387.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.71
Rate for Payer: Cigna Commercial	$646.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.09
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS CULT

Facility

$1,293.00

Service Code	HCPCS 15341
Hospital Charge Code	9808205
Hospital Revenue Code	519
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS CULT

Facility

$1,293.00

Service Code	HCPCS 15341
Hospital Charge Code	9808205
Hospital Revenue Code	519
Min. Negotiated Rate	$168.09
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$387.90
Rate for Payer: Aetna Medicare Advantage	$387.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.71
Rate for Payer: Cigna Commercial	$646.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.09
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS CULT ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808185
Hospital Revenue Code	519
Min. Negotiated Rate	$168.09
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$387.90
Rate for Payer: Aetna Medicare Advantage	$387.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.71
Rate for Payer: Cigna Commercial	$646.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.09
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APLIGRAFT TISS CULT ALLOGEN

Facility

$1,293.00

Service Code	HCPCS 15340
Hospital Charge Code	9808185
Hospital Revenue Code	519
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

WC APPLICATION SHORT LEG CAST

Facility

$1,360.45

Service Code	HCPCS 29405
Hospital Charge Code	9800162
Hospital Revenue Code	510
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$666.07
Rate for Payer: Aetna Commercial	$408.13
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$346.91
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.86
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

WC APPLICATION SHORT LEG CAST

Facility

$1,360.45

Service Code	HCPCS 29405
Hospital Charge Code	9800162
Hospital Revenue Code	510
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

WC ASPIRATION/INJ INT JT/BURSA

Facility

$740.00

Service Code	HCPCS 20605
Hospital Charge Code	9800130
Hospital Revenue Code	510
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

WC ASPIRATION/INJ INT JT/BURSA

Facility

$740.00

Service Code	HCPCS 20605
Hospital Charge Code	9800130
Hospital Revenue Code	510
Min. Negotiated Rate	$29.30
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$222.00
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.70
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

WC ASPIRATION/INJ SM JT/BURSA

Facility

$740.00

Service Code	HCPCS 20600
Hospital Charge Code	9800125
Hospital Revenue Code	510
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

WC ASPIRATION/INJ SM JT/BURSA

Facility

$740.00

Service Code	HCPCS 20600
Hospital Charge Code	9800125
Hospital Revenue Code	510
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$222.00
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.70
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

WC BILATERAL UNNA BOOT

Facility

$697.50

Service Code	HCPCS 2958050
Hospital Charge Code	9800175
Hospital Revenue Code	510
Min. Negotiated Rate	$90.67
Max. Negotiated Rate	$348.75
Rate for Payer: Aetna Commercial	$209.25
Rate for Payer: Aetna Medicare Advantage	$209.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.86
Rate for Payer: Cigna Commercial	$348.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.67
Rate for Payer: Qualcare PPO/HMO/WC	$104.62

WC BILATERAL UNNA BOOT

Facility

$697.50

Service Code	HCPCS 2958050
Hospital Charge Code	9800175
Hospital Revenue Code	510
Min. Negotiated Rate	$104.62
Max. Negotiated Rate	$104.62
Rate for Payer: Qualcare PPO/HMO/WC	$104.62

WC BX OF VULVA PERINEUM 1 LESI

Facility

$469.00

Service Code	HCPCS 56605
Hospital Charge Code	83652127
Hospital Revenue Code	361
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$70.35

WC BX OF VULVA PERINEUM 1 LESI

Facility

$469.00

Service Code	HCPCS 56605
Hospital Charge Code	83652127
Hospital Revenue Code	361
Min. Negotiated Rate	$60.97
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$140.70
Rate for Payer: Aetna Medicare Advantage	$140.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.59
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	$119.59
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.35
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

Know your out-of-pocket cost for care.

All Charges