Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTAL/8.1GM

Facility

$3.00

Hospital Charge Code	60633186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

INTEDERM 6cm X 8cm 64350013

Facility

$7,688.00

Hospital Charge Code	270633020
Hospital Revenue Code	272
Min. Negotiated Rate	$1,153.20
Max. Negotiated Rate	$1,153.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20

INTEDERM 6cm X 8cm 64350013

Facility

$7,688.00

Hospital Charge Code	270633020
Hospital Revenue Code	272
Min. Negotiated Rate	$999.44
Max. Negotiated Rate	$3,844.00
Rate for Payer: Aetna Commercial	$2,306.40
Rate for Payer: Aetna Medicare Advantage	$2,306.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,960.44
Rate for Payer: Cigna Commercial	$3,844.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.44
Rate for Payer: Oxford Commercial	$3,844.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20
Rate for Payer: UnitedHealthcare Commercial	$3,844.00

INTEGRA BILAYER DERMAL MATRIX

Facility

$14,170.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657175
Hospital Revenue Code	636
Min. Negotiated Rate	$2,125.50
Max. Negotiated Rate	$3,429.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,429.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,125.50

INTEGRA BILAYER DERMAL MATRIX

Facility

$14,170.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657175
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,251.00
Rate for Payer: Aetna Commercial	$4,251.00
Rate for Payer: Aetna Medicare Advantage	$4,251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,613.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,613.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,613.35
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,429.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,125.50

INTEGRA BIOFIX FLOW PLACT TIS

Facility

$19,375.00

Service Code	HCPCS C9399
Hospital Charge Code	270684215
Hospital Revenue Code	636
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$9,687.50
Rate for Payer: Aetna Commercial	$5,812.50
Rate for Payer: Aetna Medicare Advantage	$5,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,940.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,940.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,940.62
Rate for Payer: Cigna Commercial	$9,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,688.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,906.25

INTEGRA BIOFIX FLOW PLACT TIS

Facility

$19,375.00

Service Code	HCPCS C9399
Hospital Charge Code	270684215
Hospital Revenue Code	636
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$4,688.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,688.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,906.25

INTEGRA BONE GRAFT 2.5CC

Facility

$4,250.00

Hospital Charge Code	270657176
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

INTEGRA BONE GRAFT 2.5CC

Facility

$4,250.00

Hospital Charge Code	270657176
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

INTEGRA BONE GRAFT 5CC W/ C

Facility

$8,000.00

Hospital Charge Code	270657178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

INTEGRA BONE GRAFT 5CC W/ C

Facility

$8,000.00

Hospital Charge Code	270657178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

INTEGRA FLOWABLE WOUND MATRIX

Facility

$14,105.00

Service Code	HCPCS Q4114
Hospital Charge Code	270646968
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.75
Max. Negotiated Rate	$7,052.50
Rate for Payer: Aetna Commercial	$4,231.50
Rate for Payer: Aetna Medicare Advantage	$4,231.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,596.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,596.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,596.78
Rate for Payer: Cigna Commercial	$7,052.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,413.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.75

INTEGRA FLOWABLE WOUND MATRIX

Facility

$14,105.00

Service Code	HCPCS Q4114
Hospital Charge Code	270646968
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.75
Max. Negotiated Rate	$3,413.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,821.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,413.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.75

INTEGRAL PRIMARY/REV 13X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270688618
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$12,193.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20

INTEGRAL PRIMARY/REV 13X180

Facility

$38,760.00

Service Code	HCPCS C1776
Hospital Charge Code	270686318
Hospital Revenue Code	278
Min. Negotiated Rate	$5,814.00
Max. Negotiated Rate	$19,380.00
Rate for Payer: Aetna Commercial	$11,628.00
Rate for Payer: Aetna Medicare Advantage	$11,628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,883.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,883.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,883.80
Rate for Payer: Cigna Commercial	$19,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,379.92
Rate for Payer: Qualcare PPO/HMO/WC	$5,814.00

INTEGRAL PRIMARY/REV 13X180

Facility

$38,760.00

Service Code	HCPCS C1776
Hospital Charge Code	270686318
Hospital Revenue Code	278
Min. Negotiated Rate	$5,814.00
Max. Negotiated Rate	$9,379.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,379.92
Rate for Payer: Qualcare PPO/HMO/WC	$5,814.00

INTEGRAL PRIMARY/REV 13X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270688618
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$25,194.00
Rate for Payer: Aetna Commercial	$15,116.40
Rate for Payer: Aetna Medicare Advantage	$15,116.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,848.94
Rate for Payer: Cigna Commercial	$25,194.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20

INTEGRAL PRMRY 14x180MM 166014

Facility

$15,802.45

Hospital Charge Code	270608169
Hospital Revenue Code	278
Min. Negotiated Rate	$2,370.37
Max. Negotiated Rate	$7,901.23
Rate for Payer: Aetna Commercial	$4,740.73
Rate for Payer: Aetna Medicare Advantage	$4,740.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,029.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,029.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,160.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,029.62
Rate for Payer: Cigna Commercial	$7,901.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,370.37

INTEGRAL PRMRY 14x180MM 166014

Facility

$15,802.45

Hospital Charge Code	270608169
Hospital Revenue Code	278
Min. Negotiated Rate	$2,370.37
Max. Negotiated Rate	$3,824.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,160.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,370.37

INTEGRA POR STAND SZ8 120MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694498
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

INTEGRA POR STAND SZ8 120MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694498
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

INTEGRA SINGLE LAYER 2X2IN

Facility

$9,890.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657179
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.50
Max. Negotiated Rate	$2,393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,978.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50

INTEGRA SINGLE LAYER 2X2IN

Facility

$9,890.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657179
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,967.00
Rate for Payer: Aetna Commercial	$2,967.00
Rate for Payer: Aetna Medicare Advantage	$2,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,521.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,521.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,978.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,521.95
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50

INTEGRA SINGLE LAYER 4X5IN

Facility

$17,475.00

Hospital Charge Code	270657181
Hospital Revenue Code	636
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) 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

INTEGRA SINGLE LAYER 4X5IN

Facility

$17,475.00

Hospital Charge Code	270657181
Hospital Revenue Code	636
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
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