Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC DERMAL/EPID SUBS/TISS PR SQ

Facility

$213.16

Hospital Charge Code	9808170
Hospital Revenue Code	636
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$51.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.97

WC DERMAL/EPID SUBS/TISS PR SQ

Facility

$213.16

Hospital Charge Code	9808170
Hospital Revenue Code	636
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$106.58
Rate for Payer: Aetna Commercial	$63.95
Rate for Payer: Aetna Medicare Advantage	$63.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.36
Rate for Payer: Cigna Commercial	$106.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.97

WC DEST BENIGN LESIONS >15

Facility

$623.14

Service Code	HCPCS 17111
Hospital Charge Code	9808050
Hospital Revenue Code	361
Min. Negotiated Rate	$81.01
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$186.94
Rate for Payer: Aetna Medicare Advantage	$186.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.90
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	$158.90
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.01
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.47
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC DEST BENIGN LESIONS >15

Facility

$623.14

Service Code	HCPCS 17111
Hospital Charge Code	9808050
Hospital Revenue Code	361
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

WC DEST BENIGN LESIONS-UP TO 1

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	9808045
Hospital Revenue Code	361
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

WC DEST BENIGN LESIONS-UP TO 1

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	9808045
Hospital Revenue Code	361
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
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	$94.86
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC DESTRUCTION VULVA LESIONS

Facility

$651.00

Service Code	HCPCS 57061
Hospital Charge Code	83652129
Hospital Revenue Code	361
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$195.30
Rate for Payer: Aetna Medicare Advantage	$195.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.00
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	$166.00
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.63
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.65
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

WC DESTRUCTION VULVA LESIONS

Facility

$651.00

Service Code	HCPCS 57061
Hospital Charge Code	83652129
Hospital Revenue Code	361
Min. Negotiated Rate	$97.65
Max. Negotiated Rate	$97.65
Rate for Payer: Qualcare PPO/HMO/WC	$97.65

WC DRAIN BLOOD NAIL

Facility

$170.00

Service Code	HCPCS 11740
Hospital Charge Code	9800055
Hospital Revenue Code	510
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

WC DRAIN BLOOD NAIL

Facility

$170.00

Service Code	HCPCS 11740
Hospital Charge Code	9800055
Hospital Revenue Code	510
Min. Negotiated Rate	$18.66
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Better Health Medicaid	$193.50
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37

WC DRBRID LESS OR EQUAL 20SQCM

Facility

$843.00

Service Code	HCPCS 97597
Hospital Charge Code	9800076
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

WC DRBRID LESS OR EQUAL 20SQCM

Facility

$843.00

Service Code	HCPCS 97597
Hospital Charge Code	9800076
Hospital Revenue Code	510
Min. Negotiated Rate	$109.59
Max. Negotiated Rate	$477.79
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	$373.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.59
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

WC DRESSING 4.34 SQ IN

Facility

$43.00

Service Code	HCPCS A6021
Hospital Charge Code	9808065
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

WC DRESSING 4.34 SQ IN

Facility

$43.00

Service Code	HCPCS A6021
Hospital Charge Code	9808065
Hospital Revenue Code	272
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$29.97
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$29.97
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

WC DYNAFLEX MULTI COMPRESS

Facility

$71.00

Hospital Charge Code	9808260
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

WC DYNAFLEX MULTI COMPRESS

Facility

$71.00

Hospital Charge Code	9808260
Hospital Revenue Code	270
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

WC ENDOMETRIAL SAMPLING W/WO B

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	83652151
Hospital Revenue Code	361
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$200.70
Rate for Payer: Aetna Medicare Advantage	$200.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.59
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	$170.59
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.97
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC ENDOMETRIAL SAMPLING W/WO B

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	83652151
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

WC ENDOMETRL CURETTAGE-NO D&C

Facility

$722.00

Service Code	HCPCS 57505
Hospital Charge Code	83652147
Hospital Revenue Code	361
Min. Negotiated Rate	$93.86
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$216.60
Rate for Payer: Aetna Medicare Advantage	$216.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.11
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	$184.11
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.86
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.30
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

WC ENDOMETRL CURETTAGE-NO D&C

Facility

$722.00

Service Code	HCPCS 57505
Hospital Charge Code	83652147
Hospital Revenue Code	361
Min. Negotiated Rate	$108.30
Max. Negotiated Rate	$108.30
Rate for Payer: Qualcare PPO/HMO/WC	$108.30

WC ENGERIX 20MCG/1ML/HEP B AD

Facility

$114.00

Service Code	HCPCS 90746
Hospital Charge Code	83652339
Hospital Revenue Code	636
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$27.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

WC ENGERIX 20MCG/1ML/HEP B AD

Facility

$114.00

Service Code	HCPCS 90746
Hospital Charge Code	83652339
Hospital Revenue Code	636
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$75.15
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$75.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

WC EST.PT.COMPREHENSIVE H C

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	83652411
Hospital Revenue Code	514
Min. Negotiated Rate	$135.96
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$364.14
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.79
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

WC EST.PT.COMPREHENSIVE H C

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	83652411
Hospital Revenue Code	514
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

WC EXCISION LESION DIAM .6-1.0

Facility

$3,473.00

Service Code	HCPCS 11421
Hospital Charge Code	9808010
Hospital Revenue Code	361
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

Know your out-of-pocket cost for care.

All Charges