Heights University Hospital

All Charges

Charge

Type

Setting

Price

ACTISHIELD BARRIER GRAFT 2X4CM

Facility

$15,000.00

Service Code	HCPCS V2790
Hospital Charge Code	270700803
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

ACTISHIELD BARRIER GRAFT 2X4CM

Facility

$15,000.00

Service Code	HCPCS V2790
Hospital Charge Code	270700803
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

ACTIVASE 100MG

Facility

$15,916.00

Hospital Charge Code	60635012
Hospital Revenue Code	636
Min. Negotiated Rate	$2,387.40
Max. Negotiated Rate	$3,851.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,851.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,387.40

ACTIVASE 100MG

Facility

$15,916.00

Hospital Charge Code	60635012
Hospital Revenue Code	636
Min. Negotiated Rate	$2,387.40
Max. Negotiated Rate	$7,958.00
Rate for Payer: Aetna Commercial	$4,774.80
Rate for Payer: Aetna Medicare Advantage	$4,774.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,058.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,058.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,058.58
Rate for Payer: Cigna Commercial	$7,958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,851.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,387.40

ACTIVASE 100MG (TRANSPORT

Facility

$17,133.00

Hospital Charge Code	60635393
Hospital Revenue Code	636
Min. Negotiated Rate	$2,569.95
Max. Negotiated Rate	$8,566.50
Rate for Payer: Aetna Commercial	$5,139.90
Rate for Payer: Aetna Medicare Advantage	$5,139.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,368.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,368.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,368.91
Rate for Payer: Cigna Commercial	$8,566.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,146.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.95

ACTIVASE 100MG (TRANSPORT

Facility

$17,133.00

Hospital Charge Code	60635393
Hospital Revenue Code	636
Min. Negotiated Rate	$2,569.95
Max. Negotiated Rate	$4,146.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,146.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.95

ACTIVASE 50MG VIAL

Facility

$9,211.00

Hospital Charge Code	60635661
Hospital Revenue Code	636
Min. Negotiated Rate	$1,381.65
Max. Negotiated Rate	$4,605.50
Rate for Payer: Aetna Commercial	$2,763.30
Rate for Payer: Aetna Medicare Advantage	$2,763.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,348.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,348.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,348.80
Rate for Payer: Cigna Commercial	$4,605.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,229.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,381.65

ACTIVASE 50MG VIAL

Facility

$9,211.00

Hospital Charge Code	60635661
Hospital Revenue Code	636
Min. Negotiated Rate	$1,381.65
Max. Negotiated Rate	$2,229.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,229.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,381.65

ACTIVASE INJ/20MG

Facility

$3,122.00

Hospital Charge Code	60634538
Hospital Revenue Code	636
Min. Negotiated Rate	$468.30
Max. Negotiated Rate	$755.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.52
Rate for Payer: Qualcare PPO/HMO/WC	$468.30

ACTIVASE INJ/20MG

Facility

$3,122.00

Hospital Charge Code	60634538
Hospital Revenue Code	636
Min. Negotiated Rate	$468.30
Max. Negotiated Rate	$1,561.00
Rate for Payer: Aetna Commercial	$936.60
Rate for Payer: Aetna Medicare Advantage	$936.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.11
Rate for Payer: Cigna Commercial	$1,561.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.52
Rate for Payer: Qualcare PPO/HMO/WC	$468.30

ACTIVASE INJ/50MG

Facility

$7,805.00

Hospital Charge Code	60634537
Hospital Revenue Code	636
Min. Negotiated Rate	$1,170.75
Max. Negotiated Rate	$1,888.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.75

ACTIVASE INJ/50MG

Facility

$7,805.00

Hospital Charge Code	60634537
Hospital Revenue Code	636
Min. Negotiated Rate	$1,170.75
Max. Negotiated Rate	$3,902.50
Rate for Payer: Aetna Commercial	$2,341.50
Rate for Payer: Aetna Medicare Advantage	$2,341.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,990.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,990.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,990.28
Rate for Payer: Cigna Commercial	$3,902.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.75

ACTIVATED CLOTTING TIME

Facility

$390.00

Service Code	HCPCS 85175
Hospital Charge Code	5100770
Hospital Revenue Code	300
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.64
Rate for Payer: Cigna Commercial	$20.37
Rate for Payer: Cigna Medicare Advantage	$10.19
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.59
Rate for Payer: Wellcare Medicare Advantage	$20.37

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1600501
Hospital Revenue Code	300
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ACTIVATED CLOTTING TIME

Facility

$390.00

Service Code	HCPCS 85175
Hospital Charge Code	5100770
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	74110071
Hospital Revenue Code	300
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.64
Rate for Payer: Cigna Commercial	$20.37
Rate for Payer: Cigna Medicare Advantage	$10.19
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.59
Rate for Payer: Wellcare Medicare Advantage	$20.37

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1600501
Hospital Revenue Code	300
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.64
Rate for Payer: Cigna Commercial	$20.37
Rate for Payer: Cigna Medicare Advantage	$10.19
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.59
Rate for Payer: Wellcare Medicare Advantage	$20.37

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1500100
Hospital Revenue Code	300
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	74110071
Hospital Revenue Code	300
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1500100
Hospital Revenue Code	300
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.64
Rate for Payer: Cigna Commercial	$20.37
Rate for Payer: Cigna Medicare Advantage	$10.19
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.59
Rate for Payer: Wellcare Medicare Advantage	$20.37

ACTIVATED COAGULATION TIME

Facility

$29.25

Service Code	HCPCS 85347
Hospital Charge Code	3038108
Hospital Revenue Code	305
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$4.39
Rate for Payer: Qualcare PPO/HMO/WC	$4.39

ACTIVATED COAGULATION TIME

Facility

$29.25

Service Code	HCPCS 85347
Hospital Charge Code	3038108
Hospital Revenue Code	305
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.87
Rate for Payer: Aetna Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.68
Rate for Payer: Cigna Commercial	$4.28
Rate for Payer: Cigna Medicare Advantage	$2.14
Rate for Payer: Clover Medicare Advantage	$4.07
Rate for Payer: EmblemHealth Commercial	$12.84
Rate for Payer: Humana Medicare Advantage	$4.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.39
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.54
Rate for Payer: Wellcare Medicare Advantage	$4.28

ACTIVATOR NV CLIPS DSC

Facility

$2,835.00

Hospital Charge Code	270691828
Hospital Revenue Code	270
Min. Negotiated Rate	$368.55
Max. Negotiated Rate	$1,417.50
Rate for Payer: Aetna Commercial	$850.50
Rate for Payer: Aetna Medicare Advantage	$850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$722.92
Rate for Payer: Cigna Commercial	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.55
Rate for Payer: Oxford Commercial	$1,417.50
Rate for Payer: Qualcare PPO/HMO/WC	$425.25
Rate for Payer: UnitedHealthcare Commercial	$1,417.50

ACTIVATOR NV CLIPS DSC

Facility

$2,835.00

Hospital Charge Code	270691828
Hospital Revenue Code	270
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$425.25
Rate for Payer: Qualcare PPO/HMO/WC	$425.25

ACTIVE WOUND 20 CM OR LES

Facility

$411.00

Service Code	HCPCS 97597
Hospital Charge Code	94186085
Hospital Revenue Code	361
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$61.65

Know your out-of-pocket cost for care.

All Charges