Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AMNIO EXCEL 2CM X3 CM

Facility

$3,150.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684030
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

GRAFT AMNIO EXCEL 2CM X3 CM

Facility

$3,150.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684030
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

GRAFT AMNIO EXCEL 3.5 CM X 3.5

Facility

$3,412.50

Service Code	HCPCS Q4137
Hospital Charge Code	270684032
Hospital Revenue Code	278
Min. Negotiated Rate	$511.88
Max. Negotiated Rate	$825.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.83
Rate for Payer: Qualcare PPO/HMO/WC	$511.88

GRAFT AMNIO EXCEL 3.5 CM X 3.5

Facility

$3,412.50

Service Code	HCPCS Q4137
Hospital Charge Code	270684032
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,023.75
Rate for Payer: Aetna Commercial	$1,023.75
Rate for Payer: Aetna Medicare Advantage	$1,023.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$870.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$870.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$870.19
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.83
Rate for Payer: Qualcare PPO/HMO/WC	$511.88

GRAFT AMNIO EXCEL 4CMX 4 CM

Facility

$3,570.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684034
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,071.00
Rate for Payer: Aetna Commercial	$1,071.00
Rate for Payer: Aetna Medicare Advantage	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$910.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$910.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$910.35
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.94
Rate for Payer: Qualcare PPO/HMO/WC	$535.50

GRAFT AMNIO EXCEL 4CMX 4 CM

Facility

$3,570.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684034
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$863.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.94
Rate for Payer: Qualcare PPO/HMO/WC	$535.50

GRAFT AMNIO EXCEL 5CMX 5 CM

Facility

$4,025.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684033
Hospital Revenue Code	278
Min. Negotiated Rate	$603.75
Max. Negotiated Rate	$974.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$974.05
Rate for Payer: Qualcare PPO/HMO/WC	$603.75

GRAFT AMNIO EXCEL 5CMX 5 CM

Facility

$4,025.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684033
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,207.50
Rate for Payer: Aetna Commercial	$1,207.50
Rate for Payer: Aetna Medicare Advantage	$1,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,026.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,026.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,026.38
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$974.05
Rate for Payer: Qualcare PPO/HMO/WC	$603.75

GRAFT AMNIO EXCEL PER SQ CM

Facility

$278.57

Service Code	HCPCS Q4137
Hospital Charge Code	270684032W
Hospital Revenue Code	636
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$83.57
Rate for Payer: Aetna Medicare Advantage	$83.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.04
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.41
Rate for Payer: Qualcare PPO/HMO/WC	$41.79

GRAFT AMNIO EXCEL PER SQ CM

Facility

$278.57

Service Code	HCPCS Q4137
Hospital Charge Code	270684032W
Hospital Revenue Code	636
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$67.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.41
Rate for Payer: Qualcare PPO/HMO/WC	$41.79

GRAFT AMNIO MATRIX .5 ML SSPNS

Facility

$3,570.00

Service Code	HCPCS Q4139
Hospital Charge Code	270684063
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$863.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.94
Rate for Payer: Qualcare PPO/HMO/WC	$535.50

GRAFT AMNIO MATRIX .5 ML SSPNS

Facility

$3,570.00

Service Code	HCPCS Q4139
Hospital Charge Code	270684063
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,785.00
Rate for Payer: Aetna Commercial	$1,071.00
Rate for Payer: Aetna Medicare Advantage	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$910.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$910.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$910.35
Rate for Payer: Cigna Commercial	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.94
Rate for Payer: Qualcare PPO/HMO/WC	$535.50

GRAFT AMNION MATRIX 3CMX3CM

Facility

$12,250.00

Service Code	HCPCS Q4148
Hospital Charge Code	270687488
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT AMNION MATRIX 3CMX3CM

Facility

$12,250.00

Service Code	HCPCS Q4148
Hospital Charge Code	270687488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT AMNIOTIC MEMBRANE 4X8CM

Facility

$15,690.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694408
Hospital Revenue Code	278
Min. Negotiated Rate	$2,353.50
Max. Negotiated Rate	$3,796.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,796.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,353.50

GRAFT AMNIOTIC MEMBRANE 4X8CM

Facility

$15,690.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694408
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,707.00
Rate for Payer: Aetna Commercial	$4,707.00
Rate for Payer: Aetna Medicare Advantage	$4,707.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,000.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,000.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,000.95
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,796.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,353.50

GRAFT AMNITIC MEMBRANE 4X4CM

Facility

$8,225.00

Hospital Charge Code	270701104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.75
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$2,467.50
Rate for Payer: Aetna Medicare Advantage	$2,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.38
Rate for Payer: Cigna Commercial	$4,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75

GRAFT AMNITIC MEMBRANE 4X4CM

Facility

$8,225.00

Hospital Charge Code	270701104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.75
Max. Negotiated Rate	$1,990.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75

GRAFT ANTERIOR TIBIALIS SHORT

Facility

$9,725.00

Hospital Charge Code	270675480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,458.75
Max. Negotiated Rate	$4,862.50
Rate for Payer: Aetna Commercial	$2,917.50
Rate for Payer: Aetna Medicare Advantage	$2,917.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,479.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,479.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,479.88
Rate for Payer: Cigna Commercial	$4,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,353.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,458.75

GRAFT ANTERIOR TIBIALIS SHORT

Facility

$9,725.00

Hospital Charge Code	270675480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,458.75
Max. Negotiated Rate	$2,353.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,353.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,458.75

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,534.50

Service Code	HCPCS C1762
Hospital Charge Code	270675692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,580.17
Max. Negotiated Rate	$2,549.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,580.17

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,000.00

Hospital Charge Code	270666077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,000.00

Hospital Charge Code	270666077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,534.50

Service Code	HCPCS C1762
Hospital Charge Code	270675692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,580.17
Max. Negotiated Rate	$5,267.25
Rate for Payer: Aetna Commercial	$3,160.35
Rate for Payer: Aetna Medicare Advantage	$3,160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,686.30
Rate for Payer: Cigna Commercial	$5,267.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,580.17

GRAFT AORTIC A28-28/C75

Facility

$17,475.00

Hospital Charge Code	270647243C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$5,242.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

Know your out-of-pocket cost for care.

All Charges