Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$451.49
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,041.90
Rate for Payer: Aetna Medicare Advantage	$1,041.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.62
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	$885.62
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.49
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

WC EXTEN.ECZEMATOUS > 10%

Facility

$615.00

Service Code	HCPCS 11001
Hospital Charge Code	9808005
Hospital Revenue Code	361
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$184.50
Rate for Payer: Aetna Medicare Advantage	$184.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.82
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	$156.82
Rate for Payer: Cigna Commercial	$13.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.95
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC EXTEN.ECZEMATOUS > 10%

Facility

$615.00

Service Code	HCPCS 11001
Hospital Charge Code	9808005
Hospital Revenue Code	361
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$92.25

WC FETAL CONTRACTN STRESS TEST

Facility

$175.00

Service Code	HCPCS 59020
Hospital Charge Code	83652195
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

WC FETAL CONTRACTN STRESS TEST

Facility

$175.00

Service Code	HCPCS 59020
Hospital Charge Code	83652195
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$481.45
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

WC FETAL MONITORING INT.ONLY

Facility

$346.00

Service Code	HCPCS 59051
Hospital Charge Code	83652199
Hospital Revenue Code	761
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Qualcare PPO/HMO/WC	$51.90

WC FETAL MONITORING INT.ONLY

Facility

$346.00

Service Code	HCPCS 59051
Hospital Charge Code	83652199
Hospital Revenue Code	761
Min. Negotiated Rate	$39.22
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$103.80
Rate for Payer: Aetna Medicare Advantage	$103.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.23
Rate for Payer: Cigna Commercial	$39.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.98
Rate for Payer: Oxford Commercial	$173.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.90
Rate for Payer: UnitedHealthcare Commercial	$173.00

WC FOAM DRESNG, 16 SQ IN OR<W

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808135
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRESNG, 16 SQ IN OR<W

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808135
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 FOAM DRSSING 16SQ IN < W AD

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808140
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 FOAM DRSSING 16SQ IN < W AD

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808140
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSNG 16 SQ IN OR < N

Facility

$33.00

Service Code	HCPCS A6222
Hospital Charge Code	9808105
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSNG 16 SQ IN OR < N

Facility

$33.00

Service Code	HCPCS A6222
Hospital Charge Code	9808105
Hospital Revenue Code	272
Min. Negotiated Rate	$1.82
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	$3.04
Rate for Payer: Cigna Medicare Advantage	$1.82
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 GLUCOSE,BLOOD/STRIP ACCU CH

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	83652279
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WC GLUCOSE,BLOOD/STRIP ACCU CH

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	83652279
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.33
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.47
Rate for Payer: Cigna Commercial	$5.04
Rate for Payer: Cigna Medicare Advantage	$2.52
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.34
Rate for Payer: Wellcare Medicare Advantage	$5.04

WC GLUCOSE CAPIL FINGERSTIC+91

Facility

$20.85

Service Code	HCPCS 8294891
Hospital Charge Code	9800405
Hospital Revenue Code	301
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.25
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$114.00

WC GLUCOSE CAPIL FINGERSTIC+91

Facility

$20.85

Service Code	HCPCS 8294891
Hospital Charge Code	9800405
Hospital Revenue Code	301
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

WC GRAFT JACKET - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4107
Hospital Charge Code	9800225
Hospital Revenue Code	636
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

WC GRAFT JACKET - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4107
Hospital Charge Code	9800225
Hospital Revenue Code	636
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$74.70
Rate for Payer: Aetna Medicare Advantage	$74.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.49
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

WC GRAFT JACKET - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4107JW
Hospital Charge Code	9800225W
Hospital Revenue Code	636
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26

WC GRAFT JACKET - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4107JW
Hospital Charge Code	9800225W
Hospital Revenue Code	636
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$74.70
Rate for Payer: Aetna Medicare Advantage	$74.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.49
Rate for Payer: Cigna Commercial	$124.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.26
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

WC HEMOSTATIC AGENT-SPON-TRAUM

Facility

$314.00

Service Code	HCPCS 57180
Hospital Charge Code	83652133
Hospital Revenue Code	361
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

WC HEMOSTATIC AGENT-SPON-TRAUM

Facility

$314.00

Service Code	HCPCS 57180
Hospital Charge Code	83652133
Hospital Revenue Code	361
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$94.20
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.82
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC HYDROCOLLOID WND DRS REPLI

Facility

$80.00

Hospital Charge Code	9808215
Hospital Revenue Code	272
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

WC HYDROCOLLOID WND DRS REPLI

Facility

$80.00

Hospital Charge Code	9808215
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

Know your out-of-pocket cost for care.

All Charges