Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRFG AUTOL FAT LIPO 50 CC/<

Facility

$13,957.04

Service Code	HCPCS 15771
Hospital Charge Code	16000494
Hospital Revenue Code	360
Min. Negotiated Rate	$2,093.56
Max. Negotiated Rate	$2,093.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,093.56

GRFG AUTOL FAT LIPO 50 CC/<

Facility

$13,957.04

Service Code	HCPCS 15771
Hospital Charge Code	16000494
Hospital Revenue Code	360
Min. Negotiated Rate	$1,814.42
Max. Negotiated Rate	$8,439.01
Rate for Payer: Aetna Commercial	$4,187.11
Rate for Payer: Aetna Medicare Advantage	$4,187.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,559.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,559.05
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	$3,559.05
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,814.42
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,093.56
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

GRFG AUTOL FAT LIPO EA ADDL

Facility

$5,402.61

Service Code	HCPCS 15772
Hospital Charge Code	16000309
Hospital Revenue Code	360
Min. Negotiated Rate	$137.17
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,620.78
Rate for Payer: Aetna Medicare Advantage	$1,620.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.67
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	$1,377.67
Rate for Payer: Cigna Commercial	$137.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.39
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

GRFG AUTOL FAT LIPO EA ADDL

Facility

$5,402.61

Service Code	HCPCS 15772
Hospital Charge Code	16000309
Hospital Revenue Code	360
Min. Negotiated Rate	$810.39
Max. Negotiated Rate	$810.39
Rate for Payer: Qualcare PPO/HMO/WC	$810.39

GRF MATRX IQ DERM 5X4CM/SQCMJW

Facility

$300.00

Hospital Charge Code	270676216W
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GRF MATRX IQ DERM 5X4CM/SQCMJW

Facility

$300.00

Hospital Charge Code	270676216W
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GRF MATRX IQ DERMIS 5X4CM

Facility

$6,000.00

Hospital Charge Code	270676216
Hospital Revenue Code	636
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GRF MATRX IQ DERMIS 5X4CM

Facility

$6,000.00

Hospital Charge Code	270676216
Hospital Revenue Code	636
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GRF NEOX CORD 1K 3x3CM/SQCM JW

Facility

$1,244.31

Hospital Charge Code	270675812W
Hospital Revenue Code	636
Min. Negotiated Rate	$186.65
Max. Negotiated Rate	$622.15
Rate for Payer: Aetna Commercial	$373.29
Rate for Payer: Aetna Medicare Advantage	$373.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$317.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$317.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$317.30
Rate for Payer: Cigna Commercial	$622.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.12
Rate for Payer: Qualcare PPO/HMO/WC	$186.65

GRF NEOX CORD 1K 3x3CM/SQCM JW

Facility

$1,244.31

Hospital Charge Code	270675812W
Hospital Revenue Code	636
Min. Negotiated Rate	$186.65
Max. Negotiated Rate	$301.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.12
Rate for Payer: Qualcare PPO/HMO/WC	$186.65

GRFT FULL FACE/HF </= 20 SQCM

Facility

$9,070.55

Service Code	HCPCS 15240
Hospital Charge Code	323015240
Hospital Revenue Code	450
Min. Negotiated Rate	$364.67
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$2,721.16
Rate for Payer: Aetna Medicare Advantage	$2,721.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,312.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,312.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,312.99
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58

GRFT FULL FACE/HF </= 20 SQCM

Facility

$9,070.55

Service Code	HCPCS 15240
Hospital Charge Code	323015240
Hospital Revenue Code	450
Min. Negotiated Rate	$1,360.58
Max. Negotiated Rate	$1,360.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,500.00

Hospital Charge Code	270633870V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,392.00

Hospital Charge Code	270633870
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,500.00

Hospital Charge Code	270633870V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,392.00

Hospital Charge Code	270633870
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$4,017.60
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,500.00

Hospital Charge Code	270636635V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,392.00

Hospital Charge Code	270636635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$4,017.60
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,392.00

Hospital Charge Code	270636635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,500.00

Hospital Charge Code	270636635V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRID, CT GUIDE LINES BIOPSY

Facility

$575.00

Hospital Charge Code	2706000701
Hospital Revenue Code	272
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Oxford Commercial	$287.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Commercial	$287.50

GRID, CT GUIDE LINES BIOPSY

Facility

$575.00

Hospital Charge Code	2706000701
Hospital Revenue Code	272
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

GRIP SPRING 5MM 174116

Facility

$28.00

Hospital Charge Code	270622316
Hospital Revenue Code	272
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

GRIP SPRING 5MM 174116

Facility

$28.00

Hospital Charge Code	270622316
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

GRIP TROCH COBALT 120009

Facility

$4,130.00

Hospital Charge Code	270646775
Hospital Revenue Code	272
Min. Negotiated Rate	$536.90
Max. Negotiated Rate	$2,065.00
Rate for Payer: Aetna Commercial	$1,239.00
Rate for Payer: Aetna Medicare Advantage	$1,239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,053.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,053.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,053.15
Rate for Payer: Cigna Commercial	$2,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$536.90
Rate for Payer: Oxford Commercial	$2,065.00
Rate for Payer: Qualcare PPO/HMO/WC	$619.50
Rate for Payer: UnitedHealthcare Commercial	$2,065.00

Know your out-of-pocket cost for care.

All Charges