Heights University Hospital

All Charges

Charge

Type

Setting

Price

GREAT TOE LPT REG SZ 0

Facility

$9,970.00

Hospital Charge Code	270675918
Hospital Revenue Code	278
Min. Negotiated Rate	$1,495.50
Max. Negotiated Rate	$2,412.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,994.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,412.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,495.50

GREEN PANCREATIC STENT

Facility

$290.00

Hospital Charge Code	270325680
Hospital Revenue Code	278
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$70.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.18
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

GREEN PANCREATIC STENT

Facility

$290.00

Hospital Charge Code	270325680
Hospital Revenue Code	278
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$87.00
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.18
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

GRF ALLODERM 9.6x19.3CM

Facility

$25,870.00

Hospital Charge Code	270663698
Hospital Revenue Code	636
Min. Negotiated Rate	$3,880.50
Max. Negotiated Rate	$6,260.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,260.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,880.50

GRF ALLODERM 9.6x19.3CM

Facility

$25,870.00

Hospital Charge Code	270663698
Hospital Revenue Code	636
Min. Negotiated Rate	$3,880.50
Max. Negotiated Rate	$12,935.00
Rate for Payer: Aetna Commercial	$7,761.00
Rate for Payer: Aetna Medicare Advantage	$7,761.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,596.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,596.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,596.85
Rate for Payer: Cigna Commercial	$12,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,260.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,880.50

GRF ALLODERM 9.6x19.3CM/SQCMJW

Facility

$139.84

Hospital Charge Code	270663698W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$33.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$20.98

GRF ALLODERM 9.6x19.3CM/SQCMJW

Facility

$139.84

Hospital Charge Code	270663698W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna Medicare Advantage	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.66
Rate for Payer: Cigna Commercial	$69.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$20.98

GRF ALLODERM THICK 4x12CM

Facility

$9,710.00

Service Code	HCPCS Q4116
Hospital Charge Code	270633029
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,913.00
Rate for Payer: Aetna Commercial	$2,913.00
Rate for Payer: Aetna Medicare Advantage	$2,913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,476.05
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,349.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.50

GRF ALLODERM THICK 4x12CM

Facility

$9,710.00

Service Code	HCPCS Q4116
Hospital Charge Code	270633029
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,349.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,349.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.50

GRF ALLODERM THK 4x12CM/SQCMJW

Facility

$185.52

Hospital Charge Code	270633029W
Hospital Revenue Code	636
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$92.76
Rate for Payer: Aetna Commercial	$55.66
Rate for Payer: Aetna Medicare Advantage	$55.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.31
Rate for Payer: Cigna Commercial	$92.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.83

GRF ALLODERM THK 4x12CM/SQCMJW

Facility

$185.52

Hospital Charge Code	270633029W
Hospital Revenue Code	636
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$44.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.83

GRF ALLODRM CONT 164 SQCM

Facility

$32,575.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665417
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$9,772.50
Rate for Payer: Aetna Commercial	$9,772.50
Rate for Payer: Aetna Medicare Advantage	$9,772.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,306.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,306.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,306.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,883.15
Rate for Payer: Qualcare PPO/HMO/WC	$4,886.25

GRF ALLODRM CONT 164 SQCM

Facility

$32,575.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665417
Hospital Revenue Code	278
Min. Negotiated Rate	$4,886.25
Max. Negotiated Rate	$7,883.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,883.15
Rate for Payer: Qualcare PPO/HMO/WC	$4,886.25

GRF ALLODRM CONT164SQCM/SQCMJW

Facility

$195.95

Hospital Charge Code	270665417W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$47.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.42
Rate for Payer: Qualcare PPO/HMO/WC	$29.39

GRF ALLODRM CONT164SQCM/SQCMJW

Facility

$195.95

Hospital Charge Code	270665417W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$97.97
Rate for Payer: Aetna Commercial	$58.78
Rate for Payer: Aetna Medicare Advantage	$58.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.97
Rate for Payer: Cigna Commercial	$97.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.42
Rate for Payer: Qualcare PPO/HMO/WC	$29.39

GRF ALODRM 10.7x21.5CM/SQCM JW

Facility

$139.69

Hospital Charge Code	270665577W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.95
Max. Negotiated Rate	$69.84
Rate for Payer: Aetna Commercial	$41.91
Rate for Payer: Aetna Medicare Advantage	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.62
Rate for Payer: Cigna Commercial	$69.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95

GRF ALODRM 10.7x21.5CM/SQCM JW

Facility

$139.69

Hospital Charge Code	270665577W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.95
Max. Negotiated Rate	$33.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95

GRF ALODRM LG 10.7x21.5CM

Facility

$32,135.00

Hospital Charge Code	270665577
Hospital Revenue Code	636
Min. Negotiated Rate	$4,820.25
Max. Negotiated Rate	$7,776.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,776.67
Rate for Payer: Qualcare PPO/HMO/WC	$4,820.25

GRF ALODRM LG 10.7x21.5CM

Facility

$32,135.00

Hospital Charge Code	270665577
Hospital Revenue Code	636
Min. Negotiated Rate	$4,820.25
Max. Negotiated Rate	$16,067.50
Rate for Payer: Aetna Commercial	$9,640.50
Rate for Payer: Aetna Medicare Advantage	$9,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,194.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,194.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,194.42
Rate for Payer: Cigna Commercial	$16,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,776.67
Rate for Payer: Qualcare PPO/HMO/WC	$4,820.25

GRF ALODRM XTHK 16x20CM

Facility

$62,740.00

Hospital Charge Code	270646078
Hospital Revenue Code	636
Min. Negotiated Rate	$9,411.00
Max. Negotiated Rate	$31,370.00
Rate for Payer: Aetna Commercial	$18,822.00
Rate for Payer: Aetna Medicare Advantage	$18,822.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,998.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,998.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,998.70
Rate for Payer: Cigna Commercial	$31,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,183.08
Rate for Payer: Qualcare PPO/HMO/WC	$9,411.00

GRF ALODRM XTHK 16x20CM

Facility

$62,740.00

Hospital Charge Code	270646078
Hospital Revenue Code	636
Min. Negotiated Rate	$9,411.00
Max. Negotiated Rate	$15,183.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,183.08
Rate for Payer: Qualcare PPO/HMO/WC	$9,411.00

GRF ALODRM XTHK 16x20CM/SQCMJW

Facility

$196.06

Hospital Charge Code	270646078W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$47.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.45
Rate for Payer: Qualcare PPO/HMO/WC	$29.41

GRF ALODRM XTHK 16x20CM/SQCMJW

Facility

$196.06

Hospital Charge Code	270646078W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$98.03
Rate for Payer: Aetna Commercial	$58.82
Rate for Payer: Aetna Medicare Advantage	$58.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.00
Rate for Payer: Cigna Commercial	$98.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.45
Rate for Payer: Qualcare PPO/HMO/WC	$29.41

GRFG AUTO FAT LIPO CC/<

Facility

$10,771.05

Service Code	HCPCS 15773
Hospital Charge Code	1600000358
Hospital Revenue Code	360
Min. Negotiated Rate	$1,400.24
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$3,231.32
Rate for Payer: Aetna Medicare Advantage	$3,231.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,746.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,746.62
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	$2,746.62
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,400.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

GRFG AUTO FAT LIPO CC/<

Facility

$10,771.05

Service Code	HCPCS 15773
Hospital Charge Code	1600000358
Hospital Revenue Code	360
Min. Negotiated Rate	$1,615.66
Max. Negotiated Rate	$1,615.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66

Know your out-of-pocket cost for care.

All Charges