Heights University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT VIAFLOW MATRIX 1.0CC

Facility

$25,580.00

Service Code	HCPCS C1734
Hospital Charge Code	270700503
Hospital Revenue Code	278
Min. Negotiated Rate	$3,837.00
Max. Negotiated Rate	$12,790.00
Rate for Payer: Aetna Commercial	$7,674.00
Rate for Payer: Aetna Medicare Advantage	$7,674.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,522.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,522.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,522.90
Rate for Payer: Cigna Commercial	$12,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,190.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,837.00

ALLOGRAFT VIAFLOW MATRIX 1.0CC

Facility

$25,580.00

Service Code	HCPCS C1734
Hospital Charge Code	270700503
Hospital Revenue Code	278
Min. Negotiated Rate	$3,837.00
Max. Negotiated Rate	$6,190.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,190.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,837.00

ALLOGRAFT VIAGENEX MAX 3X5CM

Facility

$8,500.00

Service Code	HCPCS Q4205
Hospital Charge Code	270699124
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

ALLOGRAFT VIAGENEX MAX 3X5CM

Facility

$8,500.00

Service Code	HCPCS Q4205
Hospital Charge Code	270699124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

ALLOGRFT MESH 1:1 5x23CM101510

Facility

$6,152.50

Hospital Charge Code	270642024
Hospital Revenue Code	636
Min. Negotiated Rate	$922.88
Max. Negotiated Rate	$1,488.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,488.90
Rate for Payer: Qualcare PPO/HMO/WC	$922.88

ALLOGRFT MESH 1:1 5x23CM101510

Facility

$6,152.50

Hospital Charge Code	270642024
Hospital Revenue Code	636
Min. Negotiated Rate	$922.88
Max. Negotiated Rate	$3,076.25
Rate for Payer: Aetna Commercial	$1,845.75
Rate for Payer: Aetna Medicare Advantage	$1,845.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,568.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,568.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,568.89
Rate for Payer: Cigna Commercial	$3,076.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,488.90
Rate for Payer: Qualcare PPO/HMO/WC	$922.88

ALLOMATRIX 10CC

Facility

$5,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270677317
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$2,650.00
Rate for Payer: Aetna Commercial	$1,590.00
Rate for Payer: Aetna Medicare Advantage	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,351.50
Rate for Payer: Cigna Commercial	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

ALLOMATRIX 10CC

Facility

$5,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270677317
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$1,282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

ALLOMATRIX 5CC PUTTY

Facility

$8,715.00

Service Code	HCPCS C9359
Hospital Charge Code	270665925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.25
Max. Negotiated Rate	$2,109.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25

ALLOMATRIX 5CC PUTTY

Facility

$8,715.00

Service Code	HCPCS C9359
Hospital Charge Code	270665925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.25
Max. Negotiated Rate	$4,357.50
Rate for Payer: Aetna Commercial	$2,614.50
Rate for Payer: Aetna Medicare Advantage	$2,614.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,222.32
Rate for Payer: Cigna Commercial	$4,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25

ALLOPATCH HD THICK 4CMx8CM

Facility

$8,840.00

Service Code	HCPCS Q4128
Hospital Charge Code	270683019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,139.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,139.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.00

ALLOPATCH HD THICK 4CMx8CM

Facility

$8,840.00

Service Code	HCPCS Q4128
Hospital Charge Code	270683019
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,652.00
Rate for Payer: Aetna Commercial	$2,652.00
Rate for Payer: Aetna Medicare Advantage	$2,652.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,254.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,254.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,254.20
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,139.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.00

ALLOPURE 8MM EVANS

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270682192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$2,116.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

ALLOPURE 8MM EVANS

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270682192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$4,372.50
Rate for Payer: Aetna Commercial	$2,623.50
Rate for Payer: Aetna Medicare Advantage	$2,623.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.97
Rate for Payer: Cigna Commercial	$4,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

ALLOPURETRICORTICAL BLOCK-MEDI

Facility

$18,754.75

Service Code	HCPCS C1889
Hospital Charge Code	270704023
Hospital Revenue Code	278
Min. Negotiated Rate	$2,813.21
Max. Negotiated Rate	$9,377.38
Rate for Payer: Aetna Commercial	$5,626.43
Rate for Payer: Aetna Medicare Advantage	$5,626.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,782.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,782.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,782.46
Rate for Payer: Cigna Commercial	$9,377.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,538.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,813.21

ALLOPURETRICORTICAL BLOCK-MEDI

Facility

$18,754.75

Service Code	HCPCS C1889
Hospital Charge Code	270704023
Hospital Revenue Code	278
Min. Negotiated Rate	$2,813.21
Max. Negotiated Rate	$4,538.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,538.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,813.21

ALLOPURINOL 100 MG TAB

Facility

$4.00

Service Code	NDC 51079020520
Hospital Charge Code	60628511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL 100 MG TAB

Facility

$4.00

Service Code	NDC 51079020520
Hospital Charge Code	60628511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60632420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALLOPURINOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60632420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ALLOPURINOL 300 MG TAB

Facility

$5.09

Service Code	NDC 51079020620
Hospital Charge Code	60628512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.66
Rate for Payer: Oxford Commercial	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$2.54

Know your out-of-pocket cost for care.

All Charges