Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC PARING > 4 LESIONS

Facility

$283.75

Service Code	HCPCS 11057
Hospital Charge Code	9800110
Hospital Revenue Code	510
Min. Negotiated Rate	$36.89
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$85.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.36
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.89
Rate for Payer: Qualcare PPO/HMO/WC	$42.56

WC PARING SKIN LESION

Facility

$232.50

Service Code	HCPCS 11055
Hospital Charge Code	9800100
Hospital Revenue Code	510
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$34.88
Rate for Payer: Qualcare PPO/HMO/WC	$34.88

WC PARING SKIN LESION

Facility

$232.50

Service Code	HCPCS 11055
Hospital Charge Code	9800100
Hospital Revenue Code	510
Min. Negotiated Rate	$30.23
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$69.75
Rate for Payer: Aetna Medicare Advantage	$69.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.29
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.23
Rate for Payer: Qualcare PPO/HMO/WC	$34.88

WC PELVIC EXAM UNDER ANESTHES

Facility

$232.00

Service Code	HCPCS 57410
Hospital Charge Code	83652135
Hospital Revenue Code	761
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

WC PELVIC EXAM UNDER ANESTHES

Facility

$232.00

Service Code	HCPCS 57410
Hospital Charge Code	83652135
Hospital Revenue Code	761
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$69.60
Rate for Payer: Aetna Medicare Advantage	$69.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.16
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Oxford Commercial	$116.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Commercial	$116.00

WC PERMANENT NAIL REMOVAL

Facility

$1,375.00

Service Code	HCPCS 11750
Hospital Charge Code	9800070
Hospital Revenue Code	510
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$412.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

WC PERMANENT NAIL REMOVAL

Facility

$1,375.00

Service Code	HCPCS 11750
Hospital Charge Code	9800070
Hospital Revenue Code	510
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

WC PHAL CLSD TX W/MANIPULATION

Facility

$787.35

Service Code	HCPCS 26755
Hospital Charge Code	9800535
Hospital Revenue Code	510
Min. Negotiated Rate	$118.10
Max. Negotiated Rate	$118.10
Rate for Payer: Qualcare PPO/HMO/WC	$118.10

WC PHAL CLSD TX W/MANIPULATION

Facility

$787.35

Service Code	HCPCS 26755
Hospital Charge Code	9800535
Hospital Revenue Code	510
Min. Negotiated Rate	$102.36
Max. Negotiated Rate	$587.42
Rate for Payer: Aetna Commercial	$236.21
Rate for Payer: Aetna Medicare Advantage	$236.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.77
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.36
Rate for Payer: Qualcare PPO/HMO/WC	$118.10

WC POLYMEM ISLAND DRESSING 4X5

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808150
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC POLYMEM ISLAND DRESSING 4X5

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808150
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 POLYMEM SILVER 4X4

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808120
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$28.40
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	$28.40
Rate for Payer: Cigna Medicare Advantage	$17.04
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 POLYMEM SILVER 4X4

Facility

$40.00

Service Code	HCPCS A6210
Hospital Charge Code	9808120
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

WC PRENATAL >7 VISITS

Facility

$139.00

Service Code	HCPCS 59426
Hospital Charge Code	83652227
Hospital Revenue Code	514
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$774.48
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$774.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

WC PRENATAL >7 VISITS

Facility

$139.00

Service Code	HCPCS 59426
Hospital Charge Code	83652227
Hospital Revenue Code	514
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

WC PRIMATRIX - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4110
Hospital Charge Code	9800230
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 PRIMATRIX - PER SQ CM

Facility

$249.00

Service Code	HCPCS Q4110
Hospital Charge Code	9800230
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 PRIMATRIX - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4110JW
Hospital Charge Code	9800230W
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 PRIMATRIX - PER SQ CM JW

Facility

$249.00

Service Code	HCPCS Q4110JW
Hospital Charge Code	9800230W
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 PROMOGRAN MATRIX WD 4.34 SQ

Facility

$43.00

Service Code	HCPCS A6021
Hospital Charge Code	9808075
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

WC PROMOGRAN MATRIX WD 4.34 SQ

Facility

$43.00

Service Code	HCPCS A6021
Hospital Charge Code	9808075
Hospital Revenue Code	272
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$29.97
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$29.97
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

WC REMOVAL OF CAST

Facility

$276.50

Service Code	HCPCS 29700
Hospital Charge Code	9800165
Hospital Revenue Code	510
Min. Negotiated Rate	$29.93
Max. Negotiated Rate	$666.07
Rate for Payer: Aetna Commercial	$82.95
Rate for Payer: Aetna Medicare Advantage	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.51
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.95
Rate for Payer: Qualcare PPO/HMO/WC	$41.48

WC REMOVAL OF CAST

Facility

$276.50

Service Code	HCPCS 29700
Hospital Charge Code	9800165
Hospital Revenue Code	510
Min. Negotiated Rate	$41.48
Max. Negotiated Rate	$41.48
Rate for Payer: Qualcare PPO/HMO/WC	$41.48

WC REMOVAL OF FB, SUBQ FOOT

Facility

$1,603.75

Service Code	HCPCS 28190
Hospital Charge Code	9800135
Hospital Revenue Code	510
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$1,686.34
Rate for Payer: Aetna Commercial	$481.12
Rate for Payer: Aetna Medicare Advantage	$481.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.96
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	$408.96
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.49
Rate for Payer: Qualcare PPO/HMO/WC	$240.56

WC REMOVAL OF FB, SUBQ FOOT

Facility

$1,603.75

Service Code	HCPCS 28190
Hospital Charge Code	9800135
Hospital Revenue Code	510
Min. Negotiated Rate	$240.56
Max. Negotiated Rate	$240.56
Rate for Payer: Qualcare PPO/HMO/WC	$240.56

Know your out-of-pocket cost for care.

All Charges