Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC SKIN SUB TR/AR/L ADD 100 CM

Facility

$1,183.95

Service Code	HCPCS 15274
Hospital Charge Code	9800205
Hospital Revenue Code	510
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$355.19
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$42.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB TR/AR/L ADD 25CM

Facility

$1,183.95

Service Code	HCPCS 15272KX
Hospital Charge Code	9800505
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB TR/AR/L ADD 25CM

Facility

$1,183.95

Service Code	HCPCS 15272KX
Hospital Charge Code	9800505
Hospital Revenue Code	510
Min. Negotiated Rate	$153.91
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB TR/AR/L FIRST 100C

Facility

$1,183.95

Service Code	HCPCS 15273
Hospital Charge Code	9800200
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB TR/AR/L FIRST 100C

Facility

$1,183.95

Service Code	HCPCS 15273
Hospital Charge Code	9800200
Hospital Revenue Code	510
Min. Negotiated Rate	$153.91
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB TR/AR/L FIRST 25CM

Facility

$1,183.95

Service Code	HCPCS 15271KX
Hospital Charge Code	9800500
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKIN SUB TR/AR/L FIRST 25CM

Facility

$1,183.95

Service Code	HCPCS 15271KX
Hospital Charge Code	9800500
Hospital Revenue Code	510
Min. Negotiated Rate	$153.91
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SKN GRAFT TO FACE EA ADD 25

Facility

$496.50

Service Code	HCPCS 15276
Hospital Charge Code	9808040
Hospital Revenue Code	519
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$148.95
Rate for Payer: Aetna Commercial	$148.95
Rate for Payer: Aetna Medicare Advantage	$148.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.61
Rate for Payer: Cigna Commercial	$23.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.55
Rate for Payer: Qualcare PPO/HMO/WC	$74.47

WC SKN GRAFT TO FACE EA ADD 25

Facility

$496.50

Service Code	HCPCS 15276
Hospital Charge Code	9808040
Hospital Revenue Code	519
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$74.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.47

WC SKN GRAFT TO FACE INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15275
Hospital Charge Code	9808035
Hospital Revenue Code	519
Min. Negotiated Rate	$99.67
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$406.12
Rate for Payer: Aetna Medicare Advantage	$406.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.20
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$203.06

WC SKN GRAFT TO FACE INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15275
Hospital Charge Code	9808035
Hospital Revenue Code	519
Min. Negotiated Rate	$203.06
Max. Negotiated Rate	$203.06
Rate for Payer: Qualcare PPO/HMO/WC	$203.06

WC SKN GRAFT TO TRNK EA ADD 25

Facility

$496.50

Service Code	HCPCS 15272
Hospital Charge Code	9808030
Hospital Revenue Code	519
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$74.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.47

WC SKN GRAFT TO TRNK EA ADD 25

Facility

$496.50

Service Code	HCPCS 15272
Hospital Charge Code	9808030
Hospital Revenue Code	519
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$148.95
Rate for Payer: Aetna Commercial	$148.95
Rate for Payer: Aetna Medicare Advantage	$148.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.61
Rate for Payer: Cigna Commercial	$15.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.55
Rate for Payer: Qualcare PPO/HMO/WC	$74.47

WC SKN GRAFT TO TRNK INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15271
Hospital Charge Code	9808025
Hospital Revenue Code	519
Min. Negotiated Rate	$203.06
Max. Negotiated Rate	$203.06
Rate for Payer: Qualcare PPO/HMO/WC	$203.06

WC SKN GRAFT TO TRNK INT 25 SQ

Facility

$1,353.72

Service Code	HCPCS 15271
Hospital Charge Code	9808025
Hospital Revenue Code	519
Min. Negotiated Rate	$93.56
Max. Negotiated Rate	$1,760.02
Rate for Payer: Aetna Commercial	$406.12
Rate for Payer: Aetna Medicare Advantage	$406.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.20
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$203.06

WC SOF-FOAM DRESSING 3X3

Facility

$15.00

Hospital Charge Code	9808235
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 SOF-FOAM DRESSING 3X3

Facility

$15.00

Hospital Charge Code	9808235
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WC SPIRATION/INJ GANGLION CYST

Facility

$1,434.65

Service Code	HCPCS 20612
Hospital Charge Code	9800530
Hospital Revenue Code	510
Min. Negotiated Rate	$215.20
Max. Negotiated Rate	$215.20
Rate for Payer: Qualcare PPO/HMO/WC	$215.20

WC SPIRATION/INJ GANGLION CYST

Facility

$1,434.65

Service Code	HCPCS 20612
Hospital Charge Code	9800530
Hospital Revenue Code	510
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$430.39
Rate for Payer: Aetna Medicare Advantage	$430.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.50
Rate for Payer: Qualcare PPO/HMO/WC	$215.20

WC STRAPPING FOOT

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808057
Hospital Revenue Code	361
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$140.62
Rate for Payer: Aetna Medicare Advantage	$140.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.53
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	$119.53
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC STRAPPING FOOT

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808057
Hospital Revenue Code	361
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

WC SURG PREP/HAND/FT/DIG<100CM

Facility

$1,183.95

Service Code	HCPCS 15004
Hospital Charge Code	9800190
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SURG PREP/HAND/FT/DIG<100CM

Facility

$1,183.95

Service Code	HCPCS 15004
Hospital Charge Code	9800190
Hospital Revenue Code	510
Min. Negotiated Rate	$153.91
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SURG PREP/HAN/FT/DG ADD 100

Facility

$1,183.95

Service Code	HCPCS 15005
Hospital Charge Code	9800195
Hospital Revenue Code	510
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$355.19
Rate for Payer: Aetna Commercial	$355.19
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$84.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SURG PREP/HAN/FT/DG ADD 100

Facility

$1,183.95

Service Code	HCPCS 15005
Hospital Charge Code	9800195
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

Know your out-of-pocket cost for care.

All Charges