Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ALLODERM 3cmx7cm 102022

Facility

$3,525.00

Hospital Charge Code	270639358
Hospital Revenue Code	636
Min. Negotiated Rate	$528.75
Max. Negotiated Rate	$853.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.05
Rate for Payer: Qualcare PPO/HMO/WC	$528.75

GRAFT ALLODERM 3cmx7cm 102022

Facility

$3,525.00

Hospital Charge Code	270639358
Hospital Revenue Code	636
Min. Negotiated Rate	$528.75
Max. Negotiated Rate	$1,762.50
Rate for Payer: Aetna Commercial	$1,057.50
Rate for Payer: Aetna Medicare Advantage	$1,057.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$898.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$898.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$898.88
Rate for Payer: Cigna Commercial	$1,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.05
Rate for Payer: Qualcare PPO/HMO/WC	$528.75

GRAFT ALLODERM 4cmX22cm 101520

Facility

$4,659.60

Hospital Charge Code	270639961
Hospital Revenue Code	636
Min. Negotiated Rate	$698.94
Max. Negotiated Rate	$1,127.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,127.62
Rate for Payer: Qualcare PPO/HMO/WC	$698.94

GRAFT ALLODERM 4cmX22cm 101520

Facility

$4,659.60

Hospital Charge Code	270639961
Hospital Revenue Code	636
Min. Negotiated Rate	$698.94
Max. Negotiated Rate	$2,329.80
Rate for Payer: Aetna Commercial	$1,397.88
Rate for Payer: Aetna Medicare Advantage	$1,397.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,188.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,188.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,188.20
Rate for Payer: Cigna Commercial	$2,329.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,127.62
Rate for Payer: Qualcare PPO/HMO/WC	$698.94

GRAFT ALLODERM 4X12CM

Facility

$1,859.00

Hospital Charge Code	270664937
Hospital Revenue Code	636
Min. Negotiated Rate	$278.85
Max. Negotiated Rate	$929.50
Rate for Payer: Aetna Commercial	$557.70
Rate for Payer: Aetna Medicare Advantage	$557.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$474.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$474.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$474.05
Rate for Payer: Cigna Commercial	$929.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.88
Rate for Payer: Qualcare PPO/HMO/WC	$278.85

GRAFT ALLODERM 4X12CM

Facility

$1,859.00

Hospital Charge Code	270664937
Hospital Revenue Code	636
Min. Negotiated Rate	$278.85
Max. Negotiated Rate	$449.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.88
Rate for Payer: Qualcare PPO/HMO/WC	$278.85

GRAFT ALLODERM 4X12CM/SQCMJW

Facility

$38.73

Hospital Charge Code	270664937W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$19.36
Rate for Payer: Aetna Commercial	$11.62
Rate for Payer: Aetna Medicare Advantage	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.88
Rate for Payer: Cigna Commercial	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.81

GRAFT ALLODERM 4X12CM/SQCMJW

Facility

$38.73

Hospital Charge Code	270664937W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$9.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.81

GRAFT ALLODERM ACELLULR 101010

Facility

$8,643.25

Hospital Charge Code	270626611
Hospital Revenue Code	636
Min. Negotiated Rate	$1,296.49
Max. Negotiated Rate	$2,091.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,091.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.49

GRAFT ALLODERM ACELLULR 101010

Facility

$8,643.25

Hospital Charge Code	270626611
Hospital Revenue Code	636
Min. Negotiated Rate	$1,296.49
Max. Negotiated Rate	$4,321.62
Rate for Payer: Aetna Commercial	$2,592.97
Rate for Payer: Aetna Medicare Advantage	$2,592.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,204.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,204.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,204.03
Rate for Payer: Cigna Commercial	$4,321.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,091.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.49

graft alloderm dermal 3 x 7

Facility

$2,565.00

Hospital Charge Code	270657868
Hospital Revenue Code	636
Min. Negotiated Rate	$384.75
Max. Negotiated Rate	$1,282.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$654.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$654.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$654.08
Rate for Payer: Cigna Commercial	$1,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.73
Rate for Payer: Qualcare PPO/HMO/WC	$384.75

graft alloderm dermal 3 x 7

Facility

$2,565.00

Hospital Charge Code	270657868
Hospital Revenue Code	636
Min. Negotiated Rate	$384.75
Max. Negotiated Rate	$620.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.73
Rate for Payer: Qualcare PPO/HMO/WC	$384.75

GRAFT ALLODERM LG PERF THICK

Facility

$34,095.00

Hospital Charge Code	270677774
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

GRAFT ALLODERM LG PERF THICK

Facility

$34,095.00

Hospital Charge Code	270677774
Hospital Revenue Code	636
Min. Negotiated Rate	$5,114.25
Max. Negotiated Rate	$17,047.50
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	$17,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25

GRAFT ALLODERM MED PERF THICK

Facility

$27,445.00

Hospital Charge Code	270677773
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THICK

Facility

$27,445.00

Hospital Charge Code	270677773
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$13,722.50
Rate for Payer: Aetna Commercial	$8,233.50
Rate for Payer: Aetna Medicare Advantage	$8,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,998.48
Rate for Payer: Cigna Commercial	$13,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THIN

Facility

$27,445.00

Hospital Charge Code	270677772
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THIN

Facility

$27,445.00

Hospital Charge Code	270677772
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$13,722.50
Rate for Payer: Aetna Commercial	$8,233.50
Rate for Payer: Aetna Medicare Advantage	$8,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,998.48
Rate for Payer: Cigna Commercial	$13,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM THIN 4x12CM

Facility

$9,170.00

Service Code	HCPCS Q4116
Hospital Charge Code	270677712
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,751.00
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	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

GRAFT ALLODERM THIN 4x12CM

Facility

$9,170.00

Service Code	HCPCS Q4116
Hospital Charge Code	270677712
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

GRAFT ALLO MAT DR 3c 86DR-0300

Facility

$3,596.00

Hospital Charge Code	270635668
Hospital Revenue Code	278
Min. Negotiated Rate	$539.40
Max. Negotiated Rate	$870.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$719.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$870.23
Rate for Payer: Qualcare PPO/HMO/WC	$539.40

GRAFT ALLO MAT DR 3c 86DR-0300

Facility

$3,596.00

Hospital Charge Code	270635668
Hospital Revenue Code	278
Min. Negotiated Rate	$539.40
Max. Negotiated Rate	$1,798.00
Rate for Payer: Aetna Commercial	$1,078.80
Rate for Payer: Aetna Medicare Advantage	$1,078.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$719.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.98
Rate for Payer: Cigna Commercial	$1,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$870.23
Rate for Payer: Qualcare PPO/HMO/WC	$539.40

GRAFT ALLOSYNC 2.5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693888
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GRAFT ALLOSYNC 2.5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693888
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GRAFT ALLOSYNC DBM PUTTY 1CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690969
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

Know your out-of-pocket cost for care.

All Charges