Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC NPWT < 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97607
Hospital Charge Code	9808326
Hospital Revenue Code	510
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT < 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97607
Hospital Charge Code	9808326
Hospital Revenue Code	510
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$489.60
Rate for Payer: Aetna Medicare Advantage	$489.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$416.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$416.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$416.16
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.16
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT > 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97608
Hospital Charge Code	9808327
Hospital Revenue Code	510
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT > 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97608
Hospital Charge Code	9808327
Hospital Revenue Code	510
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$489.60
Rate for Payer: Aetna Medicare Advantage	$489.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$416.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$416.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$416.16
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.16
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT(VAC) < 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97605
Hospital Charge Code	9800410
Hospital Revenue Code	510
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$244.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NPWT(VAC) < 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97605
Hospital Charge Code	9800410
Hospital Revenue Code	510
Min. Negotiated Rate	$211.99
Max. Negotiated Rate	$489.21
Rate for Payer: Aetna Commercial	$489.21
Rate for Payer: Aetna Medicare Advantage	$489.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.83
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.99
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NPWT(VAC) > 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97606
Hospital Charge Code	9800411
Hospital Revenue Code	510
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$244.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NPWT(VAC) > 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97606
Hospital Charge Code	9800411
Hospital Revenue Code	510
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$489.21
Rate for Payer: Aetna Medicare Advantage	$489.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.83
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.99
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NU GEL DRESSING 6X8

Facility

$15.00

Hospital Charge Code	9808230
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WC NU GEL DRESSING 6X8

Facility

$15.00

Hospital Charge Code	9808230
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

WC OASIS - PER SQ CM

Facility

$36.90

Service Code	HCPCS Q4102
Hospital Charge Code	9800260
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$11.07
Rate for Payer: Aetna Medicare Advantage	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM

Facility

$36.90

Service Code	HCPCS Q4102
Hospital Charge Code	9800260
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM JW

Facility

$36.90

Service Code	HCPCS Q4102JW
Hospital Charge Code	9800260W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM JW

Facility

$36.90

Service Code	HCPCS Q4102JW
Hospital Charge Code	9800260W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$18.45
Rate for Payer: Aetna Commercial	$11.07
Rate for Payer: Aetna Medicare Advantage	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$18.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM- WASTE

Facility

$36.90

Hospital Charge Code	9800260WM
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OASIS - PER SQ CM- WASTE

Facility

$36.90

Hospital Charge Code	9800260WM
Hospital Revenue Code	636
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$18.45
Rate for Payer: Aetna Commercial	$11.07
Rate for Payer: Aetna Medicare Advantage	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$18.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

WC OP VISIT

Facility

$549.50

Hospital Charge Code	9800540
Hospital Revenue Code	510
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$82.42
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT

Facility

$549.50

Hospital Charge Code	9800540
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$274.75
Rate for Payer: Aetna Commercial	$164.85
Rate for Payer: Aetna Medicare Advantage	$164.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.12
Rate for Payer: Cigna Commercial	$274.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.44
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT W MOD

Facility

$549.50

Hospital Charge Code	9800545
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$274.75
Rate for Payer: Aetna Commercial	$164.85
Rate for Payer: Aetna Medicare Advantage	$164.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.12
Rate for Payer: Cigna Commercial	$274.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.44
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT W MOD

Facility

$549.50

Hospital Charge Code	9800545
Hospital Revenue Code	510
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$82.42
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652617
Hospital Revenue Code	636
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$42.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

WC PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652617
Hospital Revenue Code	636
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

WC PARING 2-4 LESIONS

Facility

$186.45

Service Code	HCPCS 11056
Hospital Charge Code	9800105
Hospital Revenue Code	510
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$55.94
Rate for Payer: Aetna Medicare Advantage	$55.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.54
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.24
Rate for Payer: Qualcare PPO/HMO/WC	$27.97

WC PARING 2-4 LESIONS

Facility

$186.45

Service Code	HCPCS 11056
Hospital Charge Code	9800105
Hospital Revenue Code	510
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$27.97
Rate for Payer: Qualcare PPO/HMO/WC	$27.97

WC PARING > 4 LESIONS

Facility

$283.75

Service Code	HCPCS 11057
Hospital Charge Code	9800110
Hospital Revenue Code	510
Min. Negotiated Rate	$42.56
Max. Negotiated Rate	$42.56
Rate for Payer: Qualcare PPO/HMO/WC	$42.56

Know your out-of-pocket cost for care.

All Charges