Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC DEBRIDEMENT SKIN PART THICK

Facility

$843.05

Hospital Charge Code	9800075
Hospital Revenue Code	510
Min. Negotiated Rate	$109.60
Max. Negotiated Rate	$421.52
Rate for Payer: Aetna Commercial	$252.91
Rate for Payer: Aetna Medicare Advantage	$252.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.98
Rate for Payer: Cigna Commercial	$421.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.60
Rate for Payer: Qualcare PPO/HMO/WC	$126.46

WC DEBRIDEMENT SKIN&SQTIS/BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	9800095
Hospital Revenue Code	510
Min. Negotiated Rate	$1,191.51
Max. Negotiated Rate	$1,191.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51

WC DEBRIDEMENT SKIN&SQTIS/BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	9800095
Hospital Revenue Code	510
Min. Negotiated Rate	$234.39
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Better Health Medicaid	$386.54
Rate for Payer: Aetna Commercial	$2,383.01
Rate for Payer: Aetna Medicare Advantage	$2,383.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,025.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,025.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$234.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,025.56
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,032.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27

WC DEBRIDEMENT SKIN&SQ TIS,MUS

Facility

$2,788.64

Service Code	HCPCS 11043
Hospital Charge Code	9800090
Hospital Revenue Code	510
Min. Negotiated Rate	$170.22
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$836.59
Rate for Payer: Aetna Medicare Advantage	$836.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$711.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$711.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$711.10
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.52
Rate for Payer: Qualcare PPO/HMO/WC	$418.30

WC DEBRIDEMENT SKIN&SQ TIS,MUS

Facility

$2,788.64

Service Code	HCPCS 11043
Hospital Charge Code	9800090
Hospital Revenue Code	510
Min. Negotiated Rate	$418.30
Max. Negotiated Rate	$418.30
Rate for Payer: Qualcare PPO/HMO/WC	$418.30

WC DEBRIDEMENT SKIN&SUBCU TISS

Facility

$706.05

Service Code	HCPCS 11042
Hospital Charge Code	9800085
Hospital Revenue Code	510
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$211.81
Rate for Payer: Aetna Medicare Advantage	$211.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.04
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.79
Rate for Payer: Qualcare PPO/HMO/WC	$105.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

WC DEBRIDEMENT SKIN&SUBCU TISS

Facility

$706.05

Service Code	HCPCS 11042
Hospital Charge Code	9800085
Hospital Revenue Code	510
Min. Negotiated Rate	$105.91
Max. Negotiated Rate	$105.91
Rate for Payer: Qualcare PPO/HMO/WC	$105.91

WC DEBRIDE NAILS 1-5

Facility

$256.25

Service Code	HCPCS 11720
Hospital Charge Code	9800045
Hospital Revenue Code	510
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$38.44

WC DEBRIDE NAILS 1-5

Facility

$256.25

Service Code	HCPCS 11720
Hospital Charge Code	9800045
Hospital Revenue Code	510
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$76.88
Rate for Payer: Aetna Medicare Advantage	$76.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.34
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.31
Rate for Payer: Qualcare PPO/HMO/WC	$38.44

WC DEBRIDE NAILS >5

Facility

$480.70

Service Code	HCPCS 11721
Hospital Charge Code	9800050
Hospital Revenue Code	510
Min. Negotiated Rate	$72.11
Max. Negotiated Rate	$72.11
Rate for Payer: Qualcare PPO/HMO/WC	$72.11

WC DEBRIDE NAILS >5

Facility

$480.70

Service Code	HCPCS 11721
Hospital Charge Code	9800050
Hospital Revenue Code	510
Min. Negotiated Rate	$27.24
Max. Negotiated Rate	$197.37
Rate for Payer: Aetna Better Health Medicaid	$193.50
Rate for Payer: Aetna Commercial	$144.21
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.58
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.49
Rate for Payer: Qualcare PPO/HMO/WC	$72.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37

WC DEBRID GREATER THAN 20SQCM

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9800081
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

WC DEBRID GREATER THAN 20SQCM

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9800081
Hospital Revenue Code	510
Min. Negotiated Rate	$23.41
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$23.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.59
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

WC DEBRID MUSCLE ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11046
Hospital Charge Code	9800097
Hospital Revenue Code	510
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$167.56
Rate for Payer: Qualcare PPO/HMO/WC	$167.56

WC DEBRID MUSCLE ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11046
Hospital Charge Code	9800097
Hospital Revenue Code	510
Min. Negotiated Rate	$34.81
Max. Negotiated Rate	$335.12
Rate for Payer: Aetna Commercial	$335.12
Rate for Payer: Aetna Medicare Advantage	$335.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.85
Rate for Payer: Cigna Commercial	$51.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.22
Rate for Payer: Qualcare PPO/HMO/WC	$167.56

WC DEBRID SQ ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11045
Hospital Charge Code	9800096
Hospital Revenue Code	510
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$335.12
Rate for Payer: Aetna Commercial	$335.12
Rate for Payer: Aetna Medicare Advantage	$335.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.85
Rate for Payer: Cigna Commercial	$23.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.22
Rate for Payer: Qualcare PPO/HMO/WC	$167.56

WC DEBRID SQ ADD 20 SQCM

Facility

$1,117.05

Service Code	HCPCS 11045
Hospital Charge Code	9800096
Hospital Revenue Code	510
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$167.56
Rate for Payer: Qualcare PPO/HMO/WC	$167.56

WC DEPO MEDROL 40MG VIAL

Facility

$45.00

Hospital Charge Code	9808165
Hospital Revenue Code	636
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

WC DEPO MEDROL 40MG VIAL

Facility

$45.00

Hospital Charge Code	9808165
Hospital Revenue Code	636
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

WC DERMAGRAFT - PER SQ CM

Facility

$182.70

Service Code	HCPCS Q4106
Hospital Charge Code	9800275
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$44.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT - PER SQ CM

Facility

$182.70

Service Code	HCPCS Q4106
Hospital Charge Code	9800275
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$54.81
Rate for Payer: Aetna Medicare Advantage	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.59
Rate for Payer: Cigna Commercial	$91.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT - PER SQ CM JW

Facility

$182.70

Service Code	HCPCS Q4106JW
Hospital Charge Code	9800275W
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$54.81
Rate for Payer: Aetna Medicare Advantage	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.59
Rate for Payer: Cigna Commercial	$91.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT - PER SQ CM JW

Facility

$182.70

Service Code	HCPCS Q4106JW
Hospital Charge Code	9800275W
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$44.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT PER SQ CM -WASTE

Facility

$182.70

Hospital Charge Code	9800275WM
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$44.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

WC DERMAGRAFT PER SQ CM -WASTE

Facility

$182.70

Hospital Charge Code	9800275WM
Hospital Revenue Code	636
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$54.81
Rate for Payer: Aetna Medicare Advantage	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.59
Rate for Payer: Cigna Commercial	$91.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.41

Know your out-of-pocket cost for care.

All Charges