Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC LEVEL 4 FOLLOWUP VIST+MOD2

Facility

$828.80

Service Code	HCPCS 9921425
Hospital Charge Code	9800390
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 4 INITIAL VISIT+MOD25

Facility

$1,068.20

Service Code	HCPCS 9920425
Hospital Charge Code	9800315
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

WC LEVEL 4 INITIAL VISIT+MOD25

Facility

$1,068.20

Service Code	HCPCS 9920425
Hospital Charge Code	9800315
Hospital Revenue Code	510
Min. Negotiated Rate	$138.87
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

WC LEVEL 4 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99244
Hospital Charge Code	9800345
Hospital Revenue Code	510
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$52.27
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LEVEL 4 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99244
Hospital Charge Code	9800345
Hospital Revenue Code	510
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$174.25
Rate for Payer: Aetna Commercial	$104.55
Rate for Payer: Aetna Medicare Advantage	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.87
Rate for Payer: Cigna Commercial	$174.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LEVEL 5 FOLLOWUP VIST+MOD25

Facility

$1,213.80

Service Code	HCPCS 9921525
Hospital Charge Code	9800400
Hospital Revenue Code	510
Min. Negotiated Rate	$157.79
Max. Negotiated Rate	$606.90
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	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.79
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

WC LEVEL 5 FOLLOWUP VIST+MOD25

Facility

$1,213.80

Service Code	HCPCS 9921525
Hospital Charge Code	9800400
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

WC LEVEL 5 INITIAL VISIT+MOD25

Facility

$1,450.00

Service Code	HCPCS 9920525
Hospital Charge Code	9800325
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

WC LEVEL 5 INITIAL VISIT+MOD25

Facility

$1,450.00

Service Code	HCPCS 9920525
Hospital Charge Code	9800325
Hospital Revenue Code	510
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$435.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

WC LEVEL 5 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99245
Hospital Charge Code	9800350
Hospital Revenue Code	510
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$52.27
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LEVEL 5 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99245
Hospital Charge Code	9800350
Hospital Revenue Code	510
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$174.25
Rate for Payer: Aetna Commercial	$104.55
Rate for Payer: Aetna Medicare Advantage	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.87
Rate for Payer: Cigna Commercial	$174.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LOWER LEG SPLINT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	9800155
Hospital Revenue Code	510
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$386.97
Rate for Payer: Aetna Commercial	$233.23
Rate for Payer: Aetna Medicare Advantage	$233.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.24
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.06
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

WC LOWER LEG SPLINT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	9800155
Hospital Revenue Code	510
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

WC MARZUPIALXTN BATHOLYN CYST

Facility

$2,100.00

Service Code	HCPCS 56440
Hospital Charge Code	83652123
Hospital Revenue Code	361
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

WC MARZUPIALXTN BATHOLYN CYST

Facility

$2,100.00

Service Code	HCPCS 56440
Hospital Charge Code	83652123
Hospital Revenue Code	361
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$630.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
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	$535.50
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.00
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

WC MED NUTRITION INIT 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	83652389
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

WC MED NUTRITION INIT 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	83652389
Hospital Revenue Code	942
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$28.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

WC MIRENA IUD

Facility

$284.00

Service Code	HCPCS J7298
Hospital Charge Code	83652621
Hospital Revenue Code	636
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$85.20
Rate for Payer: Aetna Medicare Advantage	$85.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.42
Rate for Payer: Cigna Commercial	$142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.73
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

WC MIRENA IUD

Facility

$284.00

Service Code	HCPCS J7298
Hospital Charge Code	83652621
Hospital Revenue Code	636
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$68.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.73
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

WC NERVE BLOCK OTHER PERIPHERA

Facility

$2,035.90

Service Code	HCPCS 64450
Hospital Charge Code	9800415
Hospital Revenue Code	510
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$1,680.99
Rate for Payer: Aetna Commercial	$610.77
Rate for Payer: Aetna Medicare Advantage	$610.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$519.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$519.15
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	$519.15
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.67
Rate for Payer: Qualcare PPO/HMO/WC	$305.38

WC NERVE BLOCK OTHER PERIPHERA

Facility

$2,035.90

Service Code	HCPCS 64450
Hospital Charge Code	9800415
Hospital Revenue Code	510
Min. Negotiated Rate	$305.38
Max. Negotiated Rate	$305.38
Rate for Payer: Qualcare PPO/HMO/WC	$305.38

WC NON AHESIVE GAUZE W NS/HYDR

Facility

$7.00

Service Code	HCPCS A6222
Hospital Charge Code	9808155
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.04
Rate for Payer: Cigna Medicare Advantage	$1.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

WC NON AHESIVE GAUZE W NS/HYDR

Facility

$7.00

Service Code	HCPCS A6222
Hospital Charge Code	9808155
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

WC NP OV E&M FOCUSED PROBLEM

Facility

$140.80

Service Code	HCPCS 99201
Hospital Charge Code	83652393
Hospital Revenue Code	514
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$21.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.12

WC NP OV E&M FOCUSED PROBLEM

Facility

$140.80

Service Code	HCPCS 99201
Hospital Charge Code	83652393
Hospital Revenue Code	514
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$70.40
Rate for Payer: Aetna Commercial	$42.24
Rate for Payer: Aetna Medicare Advantage	$42.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.90
Rate for Payer: Cigna Commercial	$70.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.12

Know your out-of-pocket cost for care.

All Charges