Heights University Hospital

All Charges

Charge

Type

Setting

Price

ALLODERM 6 CM x12 CM

Facility

$13,535.00

Service Code	HCPCS Q4116
Hospital Charge Code	270681284
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,060.50
Rate for Payer: Aetna Commercial	$4,060.50
Rate for Payer: Aetna Medicare Advantage	$4,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,451.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,451.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,707.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,451.43
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,275.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,030.25

ALLODERM CONTOUR LARGE 1MM TIC

Facility

$34,095.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665261
Hospital Revenue Code	636
Min. Negotiated Rate	$5,114.25
Max. Negotiated Rate	$8,250.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25

ALLODERM CONTOUR LARGE 1MM TIC

Facility

$34,095.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665261
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$10,228.50
Rate for Payer: Aetna Commercial	$10,228.50
Rate for Payer: Aetna Medicare Advantage	$10,228.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,694.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,694.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,694.23
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25

ALLO-DERM CONTOUR MEDIUM

Facility

$27,005.00

Hospital Charge Code	270664494
Hospital Revenue Code	636
Min. Negotiated Rate	$4,050.75
Max. Negotiated Rate	$6,535.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,535.21
Rate for Payer: Qualcare PPO/HMO/WC	$4,050.75

ALLO-DERM CONTOUR MEDIUM

Facility

$27,005.00

Hospital Charge Code	270664494
Hospital Revenue Code	636
Min. Negotiated Rate	$4,050.75
Max. Negotiated Rate	$13,502.50
Rate for Payer: Aetna Commercial	$8,101.50
Rate for Payer: Aetna Medicare Advantage	$8,101.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,886.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,886.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,886.27
Rate for Payer: Cigna Commercial	$13,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,535.21
Rate for Payer: Qualcare PPO/HMO/WC	$4,050.75

ALLODERM DERMAL GRAFT

Facility

$973.00

Hospital Charge Code	270335499
Hospital Revenue Code	636
Min. Negotiated Rate	$145.95
Max. Negotiated Rate	$486.50
Rate for Payer: Aetna Commercial	$291.90
Rate for Payer: Aetna Medicare Advantage	$291.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.12
Rate for Payer: Cigna Commercial	$486.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.95

ALLODERM DERMAL GRAFT

Facility

$973.00

Hospital Charge Code	270335499
Hospital Revenue Code	636
Min. Negotiated Rate	$145.95
Max. Negotiated Rate	$235.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.95

ALLODERM GRAFT 8X16CM

Facility

$24,450.00

Hospital Charge Code	270339540
Hospital Revenue Code	636
Min. Negotiated Rate	$3,667.50
Max. Negotiated Rate	$5,916.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,916.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,667.50

ALLODERM GRAFT 8X16CM

Facility

$24,450.00

Hospital Charge Code	270339540
Hospital Revenue Code	636
Min. Negotiated Rate	$3,667.50
Max. Negotiated Rate	$12,225.00
Rate for Payer: Aetna Commercial	$7,335.00
Rate for Payer: Aetna Medicare Advantage	$7,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,234.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,234.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,234.75
Rate for Payer: Cigna Commercial	$12,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,916.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,667.50

ALLODERM GRAFT 8X16CM/SQ CM JW

Facility

$191.02

Hospital Charge Code	270339540W
Hospital Revenue Code	636
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$95.51
Rate for Payer: Aetna Commercial	$57.31
Rate for Payer: Aetna Medicare Advantage	$57.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.71
Rate for Payer: Cigna Commercial	$95.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.23
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

ALLODERM GRAFT 8X16CM/SQ CM JW

Facility

$191.02

Hospital Charge Code	270339540W
Hospital Revenue Code	636
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$46.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.23
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

ALLODERM MEDIUM 12X20CM

Facility

$50,805.00

Service Code	HCPCS Q4116
Hospital Charge Code	270695703
Hospital Revenue Code	278
Min. Negotiated Rate	$7,620.75
Max. Negotiated Rate	$12,294.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,161.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,294.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,620.75

ALLODERM MEDIUM 12X20CM

Facility

$50,805.00

Service Code	HCPCS Q4116
Hospital Charge Code	270695703
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$15,241.50
Rate for Payer: Aetna Commercial	$15,241.50
Rate for Payer: Aetna Medicare Advantage	$15,241.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,955.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,955.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,161.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,955.27
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,294.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,620.75

ALLO DERM REGENERATIVE TISSUE

Facility

$13,755.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678871
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.25
Max. Negotiated Rate	$3,328.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.25

ALLO DERM REGENERATIVE TISSUE

Facility

$13,755.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678871
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,126.50
Rate for Payer: Aetna Commercial	$4,126.50
Rate for Payer: Aetna Medicare Advantage	$4,126.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,507.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,507.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,507.53
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.25

ALLO DERM REGEN TISSUE 4X12CMC

Facility

$9,025.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678873
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,707.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,301.38
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

ALLO DERM REGEN TISSUE 4X12CMC

Facility

$9,025.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678873
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

ALLO DERM REGEN TISSUE 4X7 CMC

Facility

$1,865.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678168
Hospital Revenue Code	278
Min. Negotiated Rate	$279.75
Max. Negotiated Rate	$559.50
Rate for Payer: Aetna Commercial	$559.50
Rate for Payer: Aetna Medicare Advantage	$559.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$475.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$475.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$475.57
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: Qualcare PPO/HMO/WC	$279.75

ALLO DERM REGEN TISSUE 4X7 CMC

Facility

$1,865.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678168
Hospital Revenue Code	278
Min. Negotiated Rate	$279.75
Max. Negotiated Rate	$451.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: Qualcare PPO/HMO/WC	$279.75

ALLODERM REG TISSUE MATRIX

Facility

$485.00

Service Code	HCPCS Q4116
Hospital Charge Code	270679527
Hospital Revenue Code	636
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$145.50
Rate for Payer: Aetna Medicare Advantage	$145.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

ALLODERM REG TISSUE MATRIX

Facility

$485.00

Service Code	HCPCS Q4116
Hospital Charge Code	270679527
Hospital Revenue Code	636
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

ALLODERM TISSUE MARIX 8X12CM

Facility

$19,080.00

Service Code	HCPCS Q4116
Hospital Charge Code	270681885
Hospital Revenue Code	278
Min. Negotiated Rate	$2,862.00
Max. Negotiated Rate	$4,617.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,617.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,862.00

ALLODERM TISSUE MARIX 8X12CM

Facility

$19,080.00

Service Code	HCPCS Q4116
Hospital Charge Code	270681885
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$5,724.00
Rate for Payer: Aetna Commercial	$5,724.00
Rate for Payer: Aetna Medicare Advantage	$5,724.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,865.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,865.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,865.40
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,617.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,862.00

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$405,242.16

Service Code	MSDRG 014
Min. Negotiated Rate	$114,206.05
Max. Negotiated Rate	$405,242.16
Rate for Payer: Aetna Commercial	$405,242.16
Rate for Payer: Aetna Medicare Advantage	$131,146.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315,917.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315,917.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120,216.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315,917.82
Rate for Payer: Cigna Medicare Advantage	$120,216.89
Rate for Payer: Clover Medicare Advantage	$114,206.05
Rate for Payer: EmblemHealth Commercial	$360,650.67
Rate for Payer: Humana Medicare Advantage	$123,823.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$120,216.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$127,429.90
Rate for Payer: Wellcare Medicare Advantage	$120,216.89

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$94,975.46

Service Code	APR-DRG 0072
Min. Negotiated Rate	$93,113.20
Max. Negotiated Rate	$94,975.46
Rate for Payer: Aetna Better Health Medicaid	$93,113.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94,975.46

Know your out-of-pocket cost for care.

All Charges