Heights University Hospital

All Charges

Charge

Type

Setting

Price

WOUND PREP ADDL 100 CM

Facility

$1,595.33

Service Code	HCPCS 15003
Hospital Charge Code	16000597
Hospital Revenue Code	360
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$478.60
Rate for Payer: Aetna Medicare Advantage	$478.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$406.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$406.81
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	$406.81
Rate for Payer: Cigna Commercial	$43.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.39
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.30
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WOUND PREP ADDL 100 CM

Facility

$1,595.33

Service Code	HCPCS 15003
Hospital Charge Code	16000597
Hospital Revenue Code	360
Min. Negotiated Rate	$239.30
Max. Negotiated Rate	$239.30
Rate for Payer: Qualcare PPO/HMO/WC	$239.30

WOUND PREP F/N/HF/G 100 SQ CM/

Facility

$2,532.16

Service Code	HCPCS 15004
Hospital Charge Code	1600000567
Hospital Revenue Code	360
Min. Negotiated Rate	$379.82
Max. Negotiated Rate	$379.82
Rate for Payer: Qualcare PPO/HMO/WC	$379.82

WOUND PREP F/N/HF/G 100 SQ CM/

Facility

$2,532.16

Service Code	HCPCS 15004
Hospital Charge Code	1600000567
Hospital Revenue Code	360
Min. Negotiated Rate	$329.18
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$759.65
Rate for Payer: Aetna Medicare Advantage	$759.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.70
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	$645.70
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.18
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$379.82
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

WOUND PREP HAND/FT/DIG,100CM

Facility

$2,674.75

Service Code	HCPCS 15004
Hospital Charge Code	323015004
Hospital Revenue Code	450
Min. Negotiated Rate	$401.21
Max. Negotiated Rate	$401.21
Rate for Payer: Qualcare PPO/HMO/WC	$401.21

WOUND PREP HAND/FT/DIG,100CM

Facility

$2,674.75

Service Code	HCPCS 15004
Hospital Charge Code	323015004
Hospital Revenue Code	450
Min. Negotiated Rate	$347.72
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$802.42
Rate for Payer: Aetna Medicare Advantage	$802.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$682.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$682.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$682.06
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.72
Rate for Payer: Qualcare PPO/HMO/WC	$401.21

WOUND PROTECTOR

Facility

$350.00

Hospital Charge Code	270686469
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

WOUND PROTECTOR

Facility

$350.00

Hospital Charge Code	270686469
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WOUND PROTECTOR RETRACTOR SM

Facility

$270.00

Hospital Charge Code	270670166
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WOUND PROTECTOR RETRACTOR SM

Facility

$270.00

Hospital Charge Code	270670166
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$135.00

WOUNDVAC CANISTER W/GEL 500ML

Facility

$163.68

Hospital Charge Code	270100015
Hospital Revenue Code	272
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$24.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.55

WOUNDVAC CANISTER W/GEL 500ML

Facility

$163.68

Hospital Charge Code	270100015
Hospital Revenue Code	272
Min. Negotiated Rate	$21.28
Max. Negotiated Rate	$81.84
Rate for Payer: Aetna Commercial	$49.10
Rate for Payer: Aetna Medicare Advantage	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.74
Rate for Payer: Cigna Commercial	$81.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.28
Rate for Payer: Oxford Commercial	$81.84
Rate for Payer: Qualcare PPO/HMO/WC	$24.55
Rate for Payer: UnitedHealthcare Commercial	$81.84

WOUNDVAC CANISTER W/O GEL

Facility

$171.65

Hospital Charge Code	270644698
Hospital Revenue Code	270
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$25.75

WOUNDVAC CANISTER W/O GEL

Facility

$171.65

Hospital Charge Code	270644698
Hospital Revenue Code	270
Min. Negotiated Rate	$22.31
Max. Negotiated Rate	$85.83
Rate for Payer: Aetna Commercial	$51.49
Rate for Payer: Aetna Medicare Advantage	$51.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.77
Rate for Payer: Cigna Commercial	$85.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.31
Rate for Payer: Oxford Commercial	$85.83
Rate for Payer: Qualcare PPO/HMO/WC	$25.75
Rate for Payer: UnitedHealthcare Commercial	$85.83

WOUNDVAC DRAPE

Facility

$35.60

Hospital Charge Code	270100025
Hospital Revenue Code	272
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

WOUNDVAC DRAPE

Facility

$35.60

Hospital Charge Code	270100025
Hospital Revenue Code	272
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: Aetna Medicare Advantage	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.08
Rate for Payer: Cigna Commercial	$17.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$17.80

WOUNDVAC DRSG BLACK LG 10PK

Facility

$245.57

Hospital Charge Code	270672868
Hospital Revenue Code	272
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$36.84

WOUNDVAC DRSG BLACK LG 10PK

Facility

$245.57

Hospital Charge Code	270672868
Hospital Revenue Code	272
Min. Negotiated Rate	$31.92
Max. Negotiated Rate	$122.78
Rate for Payer: Aetna Commercial	$73.67
Rate for Payer: Aetna Medicare Advantage	$73.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.62
Rate for Payer: Cigna Commercial	$122.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.92
Rate for Payer: Oxford Commercial	$122.78
Rate for Payer: Qualcare PPO/HMO/WC	$36.84
Rate for Payer: UnitedHealthcare Commercial	$122.78

WOUNDVAC DRSG BLACK LG 5PK

Facility

$262.71

Hospital Charge Code	270100000
Hospital Revenue Code	272
Min. Negotiated Rate	$34.15
Max. Negotiated Rate	$131.35
Rate for Payer: Aetna Commercial	$78.81
Rate for Payer: Aetna Medicare Advantage	$78.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.99
Rate for Payer: Cigna Commercial	$131.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.15
Rate for Payer: Oxford Commercial	$131.35
Rate for Payer: Qualcare PPO/HMO/WC	$39.41
Rate for Payer: UnitedHealthcare Commercial	$131.35

WOUNDVAC DRSG BLACK LG 5PK

Facility

$262.71

Hospital Charge Code	270100000
Hospital Revenue Code	272
Min. Negotiated Rate	$39.41
Max. Negotiated Rate	$39.41
Rate for Payer: Qualcare PPO/HMO/WC	$39.41

WOUNDVAC DRSG BLACK MED 10PK

Facility

$197.38

Hospital Charge Code	270672867
Hospital Revenue Code	272
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$29.61
Rate for Payer: Qualcare PPO/HMO/WC	$29.61

WOUNDVAC DRSG BLACK MED 10PK

Facility

$197.38

Hospital Charge Code	270672867
Hospital Revenue Code	272
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$98.69
Rate for Payer: Aetna Commercial	$59.21
Rate for Payer: Aetna Medicare Advantage	$59.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.33
Rate for Payer: Cigna Commercial	$98.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.66
Rate for Payer: Oxford Commercial	$98.69
Rate for Payer: Qualcare PPO/HMO/WC	$29.61
Rate for Payer: UnitedHealthcare Commercial	$98.69

WOUNDVAC DRSG BLACK MED 5PK

Facility

$217.80

Hospital Charge Code	270100005
Hospital Revenue Code	272
Min. Negotiated Rate	$32.67
Max. Negotiated Rate	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$32.67

WOUNDVAC DRSG BLACK MED 5PK

Facility

$217.80

Hospital Charge Code	270100005
Hospital Revenue Code	272
Min. Negotiated Rate	$28.31
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna Commercial	$65.34
Rate for Payer: Aetna Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.54
Rate for Payer: Cigna Commercial	$108.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Oxford Commercial	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$32.67
Rate for Payer: UnitedHealthcare Commercial	$108.90

WOUNDVAC DRSG BLACK SML 10PK

Facility

$156.54

Hospital Charge Code	270672865
Hospital Revenue Code	272
Min. Negotiated Rate	$23.48
Max. Negotiated Rate	$23.48
Rate for Payer: Qualcare PPO/HMO/WC	$23.48

Know your out-of-pocket cost for care.

All Charges