Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC LEVEL 1 INITIAL VISIT

Facility

$350.00

Service Code	HCPCS 99201
Hospital Charge Code	9800280
Hospital Revenue Code	510
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 INITIAL VISIT

Facility

$350.00

Service Code	HCPCS 99201
Hospital Charge Code	9800280
Hospital Revenue Code	510
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 INITIAL VISIT+MOD25

Facility

$350.00

Service Code	HCPCS 9920125
Hospital Charge Code	9800285
Hospital Revenue Code	510
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 INITIAL VISIT+MOD25

Facility

$350.00

Service Code	HCPCS 9920125
Hospital Charge Code	9800285
Hospital Revenue Code	510
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	9800330
Hospital Revenue Code	510
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$67.56
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.28
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 1 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	9800330
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 2 FOLLOWUP VIST+MOD25

Facility

$446.00

Service Code	HCPCS 9921225
Hospital Charge Code	9800370
Hospital Revenue Code	510
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

WC LEVEL 2 FOLLOWUP VIST+MOD25

Facility

$446.00

Service Code	HCPCS 9921225
Hospital Charge Code	9800370
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

WC LEVEL 2 I&D HEMATOMA

Facility

$3,553.75

Service Code	HCPCS 10140
Hospital Charge Code	9800025
Hospital Revenue Code	510
Min. Negotiated Rate	$533.06
Max. Negotiated Rate	$533.06
Rate for Payer: Qualcare PPO/HMO/WC	$533.06

WC LEVEL 2 I&D HEMATOMA

Facility

$3,553.75

Service Code	HCPCS 10140
Hospital Charge Code	9800025
Hospital Revenue Code	510
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,066.12
Rate for Payer: Aetna Medicare Advantage	$1,066.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$906.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$906.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$906.21
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.99
Rate for Payer: Qualcare PPO/HMO/WC	$533.06

WC LEVEL 2 INITIAL VISIT+MOD25

Facility

$474.10

Service Code	HCPCS 9920225
Hospital Charge Code	9800295
Hospital Revenue Code	510
Min. Negotiated Rate	$71.11
Max. Negotiated Rate	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

WC LEVEL 2 INITIAL VISIT+MOD25

Facility

$474.10

Service Code	HCPCS 9920225
Hospital Charge Code	9800295
Hospital Revenue Code	510
Min. Negotiated Rate	$61.63
Max. Negotiated Rate	$237.05
Rate for Payer: Aetna Commercial	$142.23
Rate for Payer: Aetna Medicare Advantage	$142.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.90
Rate for Payer: Cigna Commercial	$237.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.63
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

WC LEVEL 2 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	9800335
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 2 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	9800335
Hospital Revenue Code	510
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$67.56
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.28
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 3 FOLLOWUP VIST+MOD25

Facility

$655.20

Service Code	HCPCS 9921325
Hospital Charge Code	9800380
Hospital Revenue Code	510
Min. Negotiated Rate	$85.18
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.18
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

WC LEVEL 3 FOLLOWUP VIST+MOD25

Facility

$655.20

Service Code	HCPCS 9921325
Hospital Charge Code	9800380
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

WC LEVEL 3 I&D DR BELOW FASCIA

Facility

$5,037.05

Service Code	HCPCS 28002
Hospital Charge Code	9800035
Hospital Revenue Code	510
Min. Negotiated Rate	$68.31
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,511.12
Rate for Payer: Aetna Medicare Advantage	$1,511.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,284.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,284.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,284.45
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.82
Rate for Payer: Qualcare PPO/HMO/WC	$755.56

WC LEVEL 3 I&D DR BELOW FASCIA

Facility

$5,037.05

Service Code	HCPCS 28002
Hospital Charge Code	9800035
Hospital Revenue Code	510
Min. Negotiated Rate	$755.56
Max. Negotiated Rate	$755.56
Rate for Payer: Qualcare PPO/HMO/WC	$755.56

WC LEVEL 3 I&D DR BURSA FOOT

Facility

$3,103.75

Service Code	HCPCS 28001
Hospital Charge Code	9800030
Hospital Revenue Code	510
Min. Negotiated Rate	$465.56
Max. Negotiated Rate	$465.56
Rate for Payer: Qualcare PPO/HMO/WC	$465.56

WC LEVEL 3 I&D DR BURSA FOOT

Facility

$3,103.75

Service Code	HCPCS 28001
Hospital Charge Code	9800030
Hospital Revenue Code	510
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$931.12
Rate for Payer: Aetna Medicare Advantage	$931.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$791.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$791.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$791.46
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.49
Rate for Payer: Qualcare PPO/HMO/WC	$465.56

WC LEVEL 3 INITIAL VISIT+MOD25

Facility

$828.80

Service Code	HCPCS 9920325
Hospital Charge Code	9800305
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

WC LEVEL 3 INITIAL VISIT+MOD25

Facility

$828.80

Service Code	HCPCS 9920325
Hospital Charge Code	9800305
Hospital Revenue Code	510
Min. Negotiated Rate	$107.74
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

WC LEVEL 3 OUTPATIENT CONSULT

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	9800340
Hospital Revenue Code	510
Min. Negotiated Rate	$36.83
Max. Negotiated Rate	$36.83
Rate for Payer: Qualcare PPO/HMO/WC	$36.83

WC LEVEL 3 OUTPATIENT CONSULT

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	9800340
Hospital Revenue Code	510
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$122.75
Rate for Payer: Aetna Commercial	$73.65
Rate for Payer: Aetna Medicare Advantage	$73.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.60
Rate for Payer: Cigna Commercial	$122.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.91
Rate for Payer: Qualcare PPO/HMO/WC	$36.83

WC LEVEL 4 FOLLOWUP VIST+MOD2

Facility

$828.80

Service Code	HCPCS 9921425
Hospital Charge Code	9800390
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

Know your out-of-pocket cost for care.

All Charges