Heights University Hospital

All Charges

Charge

Type

Setting

Price

WC SURG PREP,T,A,L,110CM ADDL

Facility

$1,183.95

Service Code	HCPCS 15003
Hospital Charge Code	9800185
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,T,A,L,110CM ADDL

Facility

$1,183.95

Service Code	HCPCS 15003
Hospital Charge Code	9800185
Hospital Revenue Code	510
Min. Negotiated Rate	$43.03
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	$43.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC SURG PREP/TRK,ARM,LEG<100CM

Facility

$1,183.95

Service Code	HCPCS 15002
Hospital Charge Code	9800180
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/TRK,ARM,LEG<100CM

Facility

$1,183.95

Service Code	HCPCS 15002
Hospital Charge Code	9800180
Hospital Revenue Code	510
Min. Negotiated Rate	$153.91
Max. Negotiated Rate	$5,165.88
Rate for Payer: Aetna Better Health Medicaid	$5,064.59
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	$222.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.91
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,165.88

WC SUTURES-SIMPLE 2.5CM OR LES

Facility

$732.95

Service Code	HCPCS 12001
Hospital Charge Code	9808015
Hospital Revenue Code	361
Min. Negotiated Rate	$95.28
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$219.88
Rate for Payer: Aetna Medicare Advantage	$219.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.90
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	$186.90
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.28
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.94
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC SUTURES-SIMPLE 2.5CM OR LES

Facility

$732.95

Service Code	HCPCS 12001
Hospital Charge Code	9808015
Hospital Revenue Code	361
Min. Negotiated Rate	$109.94
Max. Negotiated Rate	$109.94
Rate for Payer: Qualcare PPO/HMO/WC	$109.94

WC SUTURES-SIMPLE 2.6CM - 7.5C

Facility

$560.00

Service Code	HCPCS 12002
Hospital Charge Code	9808020
Hospital Revenue Code	361
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

WC SUTURES-SIMPLE 2.6CM - 7.5C

Facility

$560.00

Service Code	HCPCS 12002
Hospital Charge Code	9808020
Hospital Revenue Code	361
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$168.00
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
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	$142.80
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WC THERASKIN/SQ CM

Facility

$6,475.00

Service Code	HCPCS Q4121
Hospital Charge Code	270646669
Hospital Revenue Code	636
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

WC THERASKIN/SQ CM

Facility

$6,475.00

Service Code	HCPCS Q4121
Hospital Charge Code	270646669
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,942.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

WC THERASKIN/SQ CM JW

Facility

$6,475.00

Service Code	HCPCS Q4121
Hospital Charge Code	270646669W
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,942.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

WC THERASKIN/SQ CM JW

Facility

$6,475.00

Service Code	HCPCS Q4121
Hospital Charge Code	270646669W
Hospital Revenue Code	636
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

WC TIELLE 2 3/4 X 3 1/2/

Facility

$11.00

Hospital Charge Code	9808220
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$5.50

WC TIELLE 2 3/4 X 3 1/2/

Facility

$11.00

Hospital Charge Code	9808220
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

WC TIELLE 5 7/8 X 3/4

Facility

$16.00

Hospital Charge Code	9808225
Hospital Revenue Code	272
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$8.00

WC TIELLE 5 7/8 X 3/4

Facility

$16.00

Hospital Charge Code	9808225
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

WC TOTAL CONTACT CAST - LEG

Facility

$486.70

Service Code	HCPCS 29445
Hospital Charge Code	9800160
Hospital Revenue Code	510
Min. Negotiated Rate	$63.27
Max. Negotiated Rate	$666.07
Rate for Payer: Aetna Commercial	$146.01
Rate for Payer: Aetna Medicare Advantage	$146.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.11
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.27
Rate for Payer: Qualcare PPO/HMO/WC	$73.00

WC TOTAL CONTACT CAST - LEG

Facility

$486.70

Service Code	HCPCS 29445
Hospital Charge Code	9800160
Hospital Revenue Code	510
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.00

WC TRIM NAILS

Facility

$170.00

Service Code	HCPCS 11719
Hospital Charge Code	9800040
Hospital Revenue Code	510
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

WC TRIM NAILS

Facility

$170.00

Service Code	HCPCS 11719
Hospital Charge Code	9800040
Hospital Revenue Code	510
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

WC UNNA BOOT

Facility

$348.75

Service Code	HCPCS 29580
Hospital Charge Code	9800170
Hospital Revenue Code	510
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

WC UNNA BOOT

Facility

$348.75

Service Code	HCPCS 29580
Hospital Charge Code	9800170
Hospital Revenue Code	510
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$386.97
Rate for Payer: Aetna Commercial	$104.62
Rate for Payer: Aetna Medicare Advantage	$104.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.93
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

WC UNNA BOOT LEFT

Facility

$348.75

Service Code	HCPCS 29580LT
Hospital Charge Code	9800172
Hospital Revenue Code	510
Min. Negotiated Rate	$45.34
Max. Negotiated Rate	$174.38
Rate for Payer: Aetna Commercial	$104.62
Rate for Payer: Aetna Medicare Advantage	$104.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.93
Rate for Payer: Cigna Commercial	$174.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

WC UNNA BOOT LEFT

Facility

$348.75

Service Code	HCPCS 29580LT
Hospital Charge Code	9800172
Hospital Revenue Code	510
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

WC UNNA BOOT RIGHT

Facility

$348.75

Service Code	HCPCS 29580RT
Hospital Charge Code	9800171
Hospital Revenue Code	510
Min. Negotiated Rate	$45.34
Max. Negotiated Rate	$174.38
Rate for Payer: Aetna Commercial	$104.62
Rate for Payer: Aetna Medicare Advantage	$104.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.93
Rate for Payer: Cigna Commercial	$174.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.31

Know your out-of-pocket cost for care.

All Charges