Heights University Hospital

All Charges

Charge

Type

Setting

Price

AMNIOFIX INJECTABLE 100MG

Facility

$9,170.00

Hospital Charge Code	270660769
Hospital Revenue Code	270
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOFIX INJECTABLE 100MG

Facility

$9,170.00

Hospital Charge Code	270660769
Hospital Revenue Code	270
Min. Negotiated Rate	$1,192.10
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	$1,192.10
Rate for Payer: Oxford Commercial	$4,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$4,585.00

AMNIOFIX INJECTABLE 20MG

Facility

$1,652.50

Service Code	HCPCS Q4139
Hospital Charge Code	270679818
Hospital Revenue Code	636
Min. Negotiated Rate	$247.88
Max. Negotiated Rate	$826.25
Rate for Payer: Aetna Commercial	$495.75
Rate for Payer: Aetna Medicare Advantage	$495.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$421.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$421.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$421.39
Rate for Payer: Cigna Commercial	$826.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$247.88

AMNIOFIX INJECTABLE 20MG

Facility

$1,652.50

Service Code	HCPCS Q4139
Hospital Charge Code	270679818
Hospital Revenue Code	636
Min. Negotiated Rate	$247.88
Max. Negotiated Rate	$399.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$247.88

AMNIO MATRIX 1 ML

Facility

$5,250.00

Service Code	HCPCS Q4139
Hospital Charge Code	270681918
Hospital Revenue Code	636
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

AMNIO MATRIX 1 ML

Facility

$5,250.00

Service Code	HCPCS Q4139
Hospital Charge Code	270681918
Hospital Revenue Code	636
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

AMNIO MAXX ACELLULAR 2.0ML

Facility

$9,475.00

Service Code	HCPCS C1762
Hospital Charge Code	270691770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

AMNIO MAXX ACELLULAR 2.0ML

Facility

$9,475.00

Service Code	HCPCS C1762
Hospital Charge Code	270691770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$2,842.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

AMNION MATRIX CORD 3CMX4CM

Facility

$14,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703707
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$4,200.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

AMNION MATRIX CORD 3CMX4CM

Facility

$14,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703707
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

AMNION VIASHIELD DL LAY 4X4CM

Facility

$18,335.00

Service Code	HCPCS Q4211
Hospital Charge Code	270695511
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$5,500.50
Rate for Payer: Aetna Commercial	$5,500.50
Rate for Payer: Aetna Medicare Advantage	$5,500.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,675.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,675.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,667.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,675.43
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,750.25

AMNION VIASHIELD DL LAY 4X4CM

Facility

$18,335.00

Service Code	HCPCS Q4211
Hospital Charge Code	270695511
Hospital Revenue Code	278
Min. Negotiated Rate	$2,750.25
Max. Negotiated Rate	$4,437.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,667.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,750.25

AMNION WOUND MATRIX 2cmx2cm

Facility

$3,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270679824
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

AMNION WOUND MATRIX 2cmx2cm

Facility

$3,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270679824
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,192.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

AMNIO PROCEDURE

Facility

$250.00

Service Code	HCPCS 59000
Hospital Charge Code	1800192
Hospital Revenue Code	361
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

AMNIO PROCEDURE

Facility

$250.00

Service Code	HCPCS 59000
Hospital Charge Code	1800192
Hospital Revenue Code	361
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
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	$63.75
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

AMNIOTIC FLUID TRI

Facility

$9,170.00

Hospital Charge Code	270680608
Hospital Revenue Code	278
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) NJ Health	$1,834.00
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

AMNIOTIC FLUID TRI

Facility

$9,170.00

Hospital Charge Code	270680608
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOTIC MEMBRANE ALLOGRAFT

Facility

$9,170.00

Hospital Charge Code	270660772
Hospital Revenue Code	810
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOTIC MEMBRANE ALLOGRAFT

Facility

$9,170.00

Hospital Charge Code	270660772
Hospital Revenue Code	810
Min. Negotiated Rate	$1,192.10
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	$1,192.10
Rate for Payer: Oxford Commercial	$4,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$4,585.00

AMNIOTIC MEMBRANE ALLOGRAFT 1.

Facility

$9,170.00

Hospital Charge Code	270662351+
Hospital Revenue Code	272
Min. Negotiated Rate	$1,192.10
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	$1,192.10
Rate for Payer: Oxford Commercial	$4,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$4,585.00

AMNIOTIC MEMBRANE ALLOGRAFT 1.

Facility

$9,170.00

Hospital Charge Code	270662351+
Hospital Revenue Code	272
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOTICMEMBRANE ALLOGRAFT.5ML

Facility

$4,475.00

Hospital Charge Code	270662537
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

AMNIOTICMEMBRANE ALLOGRAFT.5ML

Facility

$4,475.00

Hospital Charge Code	270662537
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

AMNIOTICMEMBRNEALLOGRAFT 7X7CM

Facility

$22,475.00

Hospital Charge Code	270662656
Hospital Revenue Code	278
Min. Negotiated Rate	$3,371.25
Max. Negotiated Rate	$5,438.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,438.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,371.25

Know your out-of-pocket cost for care.

All Charges