Heights University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT AMNIOTC MEMBRANE 3x3

Facility

$7,998.75

Service Code	HCPCS C1762
Hospital Charge Code	270658381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,199.81
Max. Negotiated Rate	$3,999.38
Rate for Payer: Aetna Commercial	$2,399.62
Rate for Payer: Aetna Medicare Advantage	$2,399.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,039.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,039.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,599.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,039.68
Rate for Payer: Cigna Commercial	$3,999.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,199.81

ALLOGRAFT AMNIOTC MEMBRANE 3x3

Facility

$7,998.75

Service Code	HCPCS C1762
Hospital Charge Code	270658381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,199.81
Max. Negotiated Rate	$1,935.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,599.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,199.81

ALLOGRAFT AMNIOTC MEMBRANE 4x4

Facility

$12,440.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633
Hospital Revenue Code	636
Min. Negotiated Rate	$1,866.00
Max. Negotiated Rate	$6,220.00
Rate for Payer: Aetna Commercial	$3,732.00
Rate for Payer: Aetna Medicare Advantage	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,172.20
Rate for Payer: Cigna Commercial	$6,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.00

ALLOGRAFT AMNIOTC MEMBRANE 4x4

Facility

$12,440.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633
Hospital Revenue Code	636
Min. Negotiated Rate	$1,866.00
Max. Negotiated Rate	$3,010.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.00

ALLOGRAFT AMNIOTC MEMBRANE 4X6

Facility

$17,690.00

Service Code	HCPCS C1762
Hospital Charge Code	270658382
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.50
Max. Negotiated Rate	$4,280.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,538.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,280.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,653.50

ALLOGRAFT AMNIOTC MEMBRANE 4X6

Facility

$17,690.00

Service Code	HCPCS C1762
Hospital Charge Code	270658382
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.50
Max. Negotiated Rate	$8,845.00
Rate for Payer: Aetna Commercial	$5,307.00
Rate for Payer: Aetna Medicare Advantage	$5,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,510.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,510.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,510.95
Rate for Payer: Cigna Commercial	$8,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,280.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,653.50

ALLOGRAFT AMNIOTIC 100MG

Facility

$7,975.00

Service Code	HCPCS C1762
Hospital Charge Code	270664471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

ALLOGRAFT AMNIOTIC 100MG

Facility

$7,975.00

Service Code	HCPCS C1762
Hospital Charge Code	270664471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

ALLOGRAFT AMNIOTIC MEMBRANE

Facility

$7,975.00

Hospital Charge Code	270666218
Hospital Revenue Code	810
Min. Negotiated Rate	$1,036.75
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.75
Rate for Payer: Oxford Commercial	$3,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$3,987.50

ALLOGRAFT AMNIOTIC MEMBRANE

Facility

$7,975.00

Hospital Charge Code	270666218
Hospital Revenue Code	810
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

ALLOGRAFT AMNIOTIC MEMBRANE 4X

Facility

$17,500.00

Hospital Charge Code	270663734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

ALLOGRAFT AMNIOTIC MEMBRANE 4X

Facility

$17,500.00

Hospital Charge Code	270663734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

ALLOGRAFT AMNIOTIC MEMBRANE4X4

Facility

$9,330.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633W
Hospital Revenue Code	636
Min. Negotiated Rate	$1,399.50
Max. Negotiated Rate	$2,257.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,257.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.50

ALLOGRAFT AMNIOTIC MEMBRANE4X4

Facility

$9,330.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633W
Hospital Revenue Code	636
Min. Negotiated Rate	$1,399.50
Max. Negotiated Rate	$4,665.00
Rate for Payer: Aetna Commercial	$2,799.00
Rate for Payer: Aetna Medicare Advantage	$2,799.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,379.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,379.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,379.15
Rate for Payer: Cigna Commercial	$4,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,257.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.50

ALLOGRAFTAMNIOTICMEMBRANE4X4CM

Facility

$15,000.00

Hospital Charge Code	270663472
Hospital Revenue Code	810
Min. Negotiated Rate	$1,950.00
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) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,950.00
Rate for Payer: Oxford Commercial	$7,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Commercial	$7,500.00

ALLOGRAFTAMNIOTICMEMBRANE4X4CM

Facility

$15,000.00

Hospital Charge Code	270663472
Hospital Revenue Code	810
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

ALLOGRAFT AMNIOTIC MENBRANE

Facility

$9,170.00

Service Code	HCPCS Q4100
Hospital Charge Code	270664960
Hospital Revenue Code	636
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$2,751.00
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

ALLOGRAFT AMNIOTIC MENBRANE

Facility

$9,170.00

Service Code	HCPCS Q4100
Hospital Charge Code	270664960
Hospital Revenue Code	636
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

ALLOGRAFT ANTIOBOTIC

Facility

$4,475.00

Hospital Charge Code	270665509
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

ALLOGRAFT ANTIOBOTIC

Facility

$4,475.00

Hospital Charge Code	270665509
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,342.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

ALLOGRAFTBIOVANCEAMNMEM2X3CM

Facility

$5,750.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698089
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

ALLOGRAFTBIOVANCEAMNMEM2X3CM

Facility

$5,750.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698089
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

ALLOGRAFTBIOVANCEAMNMEM2X4CM

Facility

$7,000.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698090
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ALLOGRAFTBIOVANCEAMNMEM2X4CM

Facility

$7,000.00

Service Code	HCPCS Q4154
Hospital Charge Code	270698090
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ALLOGRAFT BONE 10 BOOST 48DBM2

Facility

$7,000.00

Hospital Charge Code	270634500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

Know your out-of-pocket cost for care.

All Charges