Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC HYDROPOL 4 1/4 X 4 1/4/

Facility

$40.00

Hospital Charge Code	9808245
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
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	$20.00
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 HYDROPOL 4 1/4 X 4 1/4/

Facility

$40.00

Hospital Charge Code	9808245
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

WC HYDROPOL DRESS 7 X 7

Facility

$106.00

Hospital Charge Code	9808255
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

WC HYDROPOL DRESS 7 X 7

Facility

$106.00

Hospital Charge Code	9808255
Hospital Revenue Code	272
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$53.00

WC HYPERBARIC O2 TX PER 30MINS

Facility

$3,900.00

Service Code	HCPCS G0277
Hospital Charge Code	9800000
Hospital Revenue Code	413
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

WC HYPERBARIC O2 TX PER 30MINS

Facility

$3,900.00

Service Code	HCPCS G0277
Hospital Charge Code	9800000
Hospital Revenue Code	413
Min. Negotiated Rate	$327.70
Max. Negotiated Rate	$2,300.00
Rate for Payer: Aetna Commercial	$1,170.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$327.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$507.00
Rate for Payer: Oxford Commercial	$2,027.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$2,300.00

WC I&D ABSCESS COMPLCATED/MULT

Facility

$796.20

Service Code	HCPCS 10061
Hospital Charge Code	9800412
Hospital Revenue Code	510
Min. Negotiated Rate	$103.51
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$238.86
Rate for Payer: Aetna Medicare Advantage	$238.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.03
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.51
Rate for Payer: Qualcare PPO/HMO/WC	$119.43

WC I&D ABSCESS COMPLCATED/MULT

Facility

$796.20

Service Code	HCPCS 10061
Hospital Charge Code	9800412
Hospital Revenue Code	510
Min. Negotiated Rate	$119.43
Max. Negotiated Rate	$119.43
Rate for Payer: Qualcare PPO/HMO/WC	$119.43

WC INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	9800525
Hospital Revenue Code	510
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$506.53
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

WC INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	9800525
Hospital Revenue Code	510
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

WC INJECT TEN, LIG, CYST

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	9808190
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

WC INJECT TEN, LIG, CYST

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	9808190
Hospital Revenue Code	361
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$327.30
Rate for Payer: Aetna Medicare Advantage	$327.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.20
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	$278.20
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.83
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC INTEGRA -PER SQ CC

Facility

$54.90

Service Code	HCPCS Q4104
Hospital Charge Code	9800220
Hospital Revenue Code	636
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna Medicare Advantage	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.00
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

WC INTEGRA -PER SQ CC

Facility

$54.90

Service Code	HCPCS Q4104
Hospital Charge Code	9800220
Hospital Revenue Code	636
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

WC INTEGRA -PER SQ CC JW

Facility

$54.90

Service Code	HCPCS Q4104JW
Hospital Charge Code	9800220W
Hospital Revenue Code	636
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$27.45
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna Medicare Advantage	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.00
Rate for Payer: Cigna Commercial	$27.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

WC INTEGRA -PER SQ CC JW

Facility

$54.90

Service Code	HCPCS Q4104JW
Hospital Charge Code	9800220W
Hospital Revenue Code	636
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

WC LAYER VENOUS COMPRES BILAT

Facility

$892.65

Service Code	HCPCS 2958150
Hospital Charge Code	9800176M
Hospital Revenue Code	510
Min. Negotiated Rate	$133.90
Max. Negotiated Rate	$133.90
Rate for Payer: Qualcare PPO/HMO/WC	$133.90

WC LAYER VENOUS COMPRES BILAT

Facility

$892.65

Service Code	HCPCS 2958150
Hospital Charge Code	9800176M
Hospital Revenue Code	510
Min. Negotiated Rate	$116.04
Max. Negotiated Rate	$446.32
Rate for Payer: Aetna Commercial	$267.80
Rate for Payer: Aetna Medicare Advantage	$267.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.63
Rate for Payer: Cigna Commercial	$446.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.04
Rate for Payer: Qualcare PPO/HMO/WC	$133.90

WC LAYER VENOUS COMPRESSION

Facility

$788.30

Service Code	HCPCS 29581
Hospital Charge Code	9800176
Hospital Revenue Code	510
Min. Negotiated Rate	$118.25
Max. Negotiated Rate	$118.25
Rate for Payer: Qualcare PPO/HMO/WC	$118.25

WC LAYER VENOUS COMPRESSION

Facility

$788.30

Service Code	HCPCS 29581
Hospital Charge Code	9800176
Hospital Revenue Code	510
Min. Negotiated Rate	$61.63
Max. Negotiated Rate	$386.97
Rate for Payer: Aetna Commercial	$236.49
Rate for Payer: Aetna Medicare Advantage	$236.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.02
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.48
Rate for Payer: Qualcare PPO/HMO/WC	$118.25

WC LAYER VENOUS COMPRESSION LT

Facility

$595.12

Service Code	HCPCS 29581LT
Hospital Charge Code	9800276
Hospital Revenue Code	510
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$89.27
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

WC LAYER VENOUS COMPRESSION LT

Facility

$595.12

Service Code	HCPCS 29581LT
Hospital Charge Code	9800276
Hospital Revenue Code	510
Min. Negotiated Rate	$77.37
Max. Negotiated Rate	$297.56
Rate for Payer: Aetna Commercial	$178.54
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.37
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

WC LAYER VENOUS COMPRESSION RT

Facility

$595.12

Service Code	HCPCS 29581RT
Hospital Charge Code	9800277
Hospital Revenue Code	510
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$89.27
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

WC LAYER VENOUS COMPRESSION RT

Facility

$595.12

Service Code	HCPCS 29581RT
Hospital Charge Code	9800277
Hospital Revenue Code	510
Min. Negotiated Rate	$77.37
Max. Negotiated Rate	$297.56
Rate for Payer: Aetna Commercial	$178.54
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.37
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

WC LC SKIN SUB HD/FT/DG 1ST100

Facility

$2,431.36

Service Code	HCPCS C5277
Hospital Charge Code	9808315
Hospital Revenue Code	510
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Qualcare PPO/HMO/WC	$364.70

Know your out-of-pocket cost for care.

All Charges