Heights University Hospital

All Charges

Charge

Type

Setting

Price

WOUND CULTURE PANEL

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475120
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$105,027.31

Service Code	MSDRG 464
Min. Negotiated Rate	$32,372.42
Max. Negotiated Rate	$105,027.31
Rate for Payer: Aetna Commercial	$105,027.31
Rate for Payer: Aetna Medicare Advantage	$33,989.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,076.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82,701.00
Rate for Payer: Cigna Commercial	$67,031.46
Rate for Payer: Cigna Medicare Advantage	$34,076.23
Rate for Payer: Clover Medicare Advantage	$32,372.42
Rate for Payer: EmblemHealth Commercial	$102,228.69
Rate for Payer: Humana Medicare Advantage	$35,098.52
Rate for Payer: Oxford Commercial	$41,892.71
Rate for Payer: UnitedHealthcare Commercial	$47,552.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,076.23
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$36,120.80
Rate for Payer: Wellcare Medicare Advantage	$34,076.23

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$192,186.47

Service Code	MSDRG 463
Min. Negotiated Rate	$56,130.57
Max. Negotiated Rate	$192,186.47
Rate for Payer: Aetna Commercial	$192,186.47
Rate for Payer: Aetna Medicare Advantage	$62,196.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156,029.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156,029.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$59,084.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156,029.22
Rate for Payer: Cigna Commercial	$122,658.94
Rate for Payer: Cigna Medicare Advantage	$59,084.81
Rate for Payer: Clover Medicare Advantage	$56,130.57
Rate for Payer: EmblemHealth Commercial	$177,254.43
Rate for Payer: Humana Medicare Advantage	$60,857.35
Rate for Payer: Oxford Commercial	$76,658.27
Rate for Payer: UnitedHealthcare Commercial	$87,014.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$59,084.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$62,629.90
Rate for Payer: Wellcare Medicare Advantage	$59,084.81

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$64,756.47

Service Code	MSDRG 465
Min. Negotiated Rate	$19,901.28
Max. Negotiated Rate	$64,756.47
Rate for Payer: Aetna Commercial	$61,494.96
Rate for Payer: Aetna Medicare Advantage	$19,901.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,550.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,550.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,585.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,550.29
Rate for Payer: Cigna Commercial	$39,247.85
Rate for Payer: Cigna Medicare Advantage	$21,585.49
Rate for Payer: Clover Medicare Advantage	$20,506.22
Rate for Payer: EmblemHealth Commercial	$64,756.47
Rate for Payer: Humana Medicare Advantage	$22,233.05
Rate for Payer: Oxford Commercial	$24,528.76
Rate for Payer: UnitedHealthcare Commercial	$27,842.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,585.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22,880.62
Rate for Payer: Wellcare Medicare Advantage	$21,585.49

WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility

$67,392.00

Service Code	MSDRG 902
Min. Negotiated Rate	$20,892.14
Max. Negotiated Rate	$67,392.00
Rate for Payer: Aetna Commercial	$64,556.71
Rate for Payer: Aetna Medicare Advantage	$20,892.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,825.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,825.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,464.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,825.96
Rate for Payer: Cigna Commercial	$41,201.95
Rate for Payer: Cigna Medicare Advantage	$22,464.00
Rate for Payer: Clover Medicare Advantage	$21,340.80
Rate for Payer: EmblemHealth Commercial	$67,392.00
Rate for Payer: Humana Medicare Advantage	$23,137.92
Rate for Payer: Oxford Commercial	$25,750.03
Rate for Payer: UnitedHealthcare Commercial	$29,228.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,464.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23,811.84
Rate for Payer: Wellcare Medicare Advantage	$22,464.00

WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility

$141,508.87

Service Code	MSDRG 901
Min. Negotiated Rate	$42,316.69
Max. Negotiated Rate	$141,508.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$47,216.51
Rate for Payer: Aetna Commercial	$141,508.87
Rate for Payer: Aetna Medicare Advantage	$45,795.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119,365.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119,365.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44,543.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119,365.11
Rate for Payer: Cigna Commercial	$90,315.03
Rate for Payer: Cigna Medicare Advantage	$44,543.88
Rate for Payer: Clover Medicare Advantage	$42,316.69
Rate for Payer: EmblemHealth Commercial	$133,631.64
Rate for Payer: Humana Medicare Advantage	$45,880.20
Rate for Payer: Oxford Commercial	$56,444.27
Rate for Payer: UnitedHealthcare Commercial	$64,069.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$44,543.88
Rate for Payer: Wellcare Medicare Advantage	$44,543.88

WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility

$45,770.73

Service Code	MSDRG 903
Min. Negotiated Rate	$12,763.36
Max. Negotiated Rate	$45,770.73
Rate for Payer: Aetna Commercial	$39,438.78
Rate for Payer: Aetna Medicare Advantage	$12,763.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,256.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,183.08
Rate for Payer: Cigna Commercial	$25,170.96
Rate for Payer: Cigna Medicare Advantage	$15,256.91
Rate for Payer: Clover Medicare Advantage	$14,494.06
Rate for Payer: EmblemHealth Commercial	$45,770.73
Rate for Payer: Humana Medicare Advantage	$15,714.62
Rate for Payer: Oxford Commercial	$15,731.12
Rate for Payer: UnitedHealthcare Commercial	$17,856.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,256.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16,172.32
Rate for Payer: Wellcare Medicare Advantage	$15,256.91

WOUND DRAINAGE *********

Facility

$98.00

Hospital Charge Code	8001380
Hospital Revenue Code	279
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

WOUND DRAINAGE *********

Facility

$98.00

Hospital Charge Code	8001380
Hospital Revenue Code	279
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$29.40
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.74
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$49.00

WOUND DRAIN COLLECTOR 3-3/4

Facility

$59.00

Hospital Charge Code	270331141
Hospital Revenue Code	272
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

WOUND DRAIN COLLECTOR 3-3/4

Facility

$59.00

Hospital Charge Code	270331141
Hospital Revenue Code	272
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Oxford Commercial	$29.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$29.50

WOUND DRAIN POUCH 4X9

Facility

$145.00

Hospital Charge Code	270331472
Hospital Revenue Code	278
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

WOUND DRAIN POUCH 4X9

Facility

$145.00

Hospital Charge Code	270331472
Hospital Revenue Code	278
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

WOUND DRAIN W/Y ADAPTOR

Facility

$52.00

Hospital Charge Code	270605806
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

WOUND DRAIN W/Y ADAPTOR

Facility

$52.00

Hospital Charge Code	270605806
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

WOUND MATRIX 10x15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270673217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,586.25
Max. Negotiated Rate	$2,559.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,559.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25

WOUND MATRIX 10x15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270673217
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,172.50
Rate for Payer: Aetna Commercial	$3,172.50
Rate for Payer: Aetna Medicare Advantage	$3,172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,696.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,696.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,696.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,559.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25

WOUND MATRIX 10x15CM/SQCM JW

Facility

$70.50

Hospital Charge Code	270673217W
Hospital Revenue Code	636
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Commercial	$21.15
Rate for Payer: Aetna Medicare Advantage	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.98
Rate for Payer: Cigna Commercial	$35.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.57

WOUND MATRIX 10x15CM/SQCM JW

Facility

$70.50

Hospital Charge Code	270673217W
Hospital Revenue Code	636
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$17.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.57

WOUND MATRIX CYTAL 16X35CM

Facility

$40,375.00

Service Code	HCPCS Q4166
Hospital Charge Code	270700145
Hospital Revenue Code	278
Min. Negotiated Rate	$6,056.25
Max. Negotiated Rate	$9,770.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,056.25

WOUND MATRIX CYTAL 16X35CM

Facility

$40,375.00

Service Code	HCPCS Q4166
Hospital Charge Code	270700145
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$12,112.50
Rate for Payer: Aetna Commercial	$12,112.50
Rate for Payer: Aetna Medicare Advantage	$12,112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,295.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,295.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,295.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,056.25

WOUND MATRIX CYTAL 6L 10X15CM

Facility

$24,440.00

Service Code	HCPCS Q4166
Hospital Charge Code	270695955
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$7,332.00
Rate for Payer: Aetna Commercial	$7,332.00
Rate for Payer: Aetna Medicare Advantage	$7,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,232.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,232.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,888.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,232.20
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,914.48
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.00

WOUND MATRIX CYTAL 6L 10X15CM

Facility

$24,440.00

Service Code	HCPCS Q4166
Hospital Charge Code	270695955
Hospital Revenue Code	278
Min. Negotiated Rate	$3,666.00
Max. Negotiated Rate	$5,914.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,888.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,914.48
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.00

WOUND MATRIX MATRISTEM 7x10CM

Facility

$5,875.00

Service Code	HCPCS Q4166
Hospital Charge Code	270667326
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

WOUND MATRIX MATRISTEM 7x10CM

Facility

$5,875.00

Service Code	HCPCS Q4166
Hospital Charge Code	270667326
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,762.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

Know your out-of-pocket cost for care.

All Charges