Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTEGRATE-C FUSION DEVICE. 17X

Facility

$8,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270706189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INTEGRATE-C FUSION DEVICE. 17X

Facility

$8,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270706189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INTEGRATED PLATE 24MM 1 HOLE

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695935
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

INTEGRATED PLATE 24MM 1 HOLE

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695935
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

INTEGRATOR STRIPS CLASS 5

Facility

$0.64

Hospital Charge Code	270645806
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.10

INTEGRATOR STRIPS CLASS 5

Facility

$0.64

Hospital Charge Code	270645806
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna Commercial	$0.19
Rate for Payer: Aetna Medicare Advantage	$0.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.16
Rate for Payer: Cigna Commercial	$0.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.10

INTEGRA WND DRSG 2X2CM

Facility

$2,273.00

Hospital Charge Code	270332613
Hospital Revenue Code	636
Min. Negotiated Rate	$340.95
Max. Negotiated Rate	$1,136.50
Rate for Payer: Aetna Commercial	$681.90
Rate for Payer: Aetna Medicare Advantage	$681.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.62
Rate for Payer: Cigna Commercial	$1,136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.07
Rate for Payer: Qualcare PPO/HMO/WC	$340.95

INTEGRA WND DRSG 2X2CM

Facility

$2,273.00

Hospital Charge Code	270332613
Hospital Revenue Code	636
Min. Negotiated Rate	$340.95
Max. Negotiated Rate	$550.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.07
Rate for Payer: Qualcare PPO/HMO/WC	$340.95

INTEGRA WND DRSG 2X2/SQ CMJW

Facility

$568.25

Hospital Charge Code	270332613W
Hospital Revenue Code	636
Min. Negotiated Rate	$85.24
Max. Negotiated Rate	$284.12
Rate for Payer: Aetna Commercial	$170.47
Rate for Payer: Aetna Medicare Advantage	$170.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.90
Rate for Payer: Cigna Commercial	$284.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.52
Rate for Payer: Qualcare PPO/HMO/WC	$85.24

INTEGRA WND DRSG 2X2/SQ CMJW

Facility

$568.25

Hospital Charge Code	270332613W
Hospital Revenue Code	636
Min. Negotiated Rate	$85.24
Max. Negotiated Rate	$137.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.52
Rate for Payer: Qualcare PPO/HMO/WC	$85.24

INTEGRA WND DRSG 4X10CM/SQCMJW

Facility

$66.28

Hospital Charge Code	270332610W
Hospital Revenue Code	636
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$16.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

INTEGRA WND DRSG 4X10CM/SQCMJW

Facility

$66.28

Hospital Charge Code	270332610W
Hospital Revenue Code	636
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$19.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.90
Rate for Payer: Cigna Commercial	$33.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

INTEGRA WND DRSG 8X10CM

Facility

$3,743.00

Hospital Charge Code	270332612
Hospital Revenue Code	636
Min. Negotiated Rate	$561.45
Max. Negotiated Rate	$1,871.50
Rate for Payer: Aetna Commercial	$1,122.90
Rate for Payer: Aetna Medicare Advantage	$1,122.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$954.47
Rate for Payer: Cigna Commercial	$1,871.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45

INTEGRA WND DRSG 8X10CM

Facility

$3,743.00

Hospital Charge Code	270332612
Hospital Revenue Code	636
Min. Negotiated Rate	$561.45
Max. Negotiated Rate	$905.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45

INTEGRA WND DRSG 8X10/SQCMJW

Facility

$46.79

Hospital Charge Code	270332612W
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

INTEGRA WND DRSG 8X10/SQCMJW

Facility

$46.79

Hospital Charge Code	270332612W
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$23.39
Rate for Payer: Aetna Commercial	$14.04
Rate for Payer: Aetna Medicare Advantage	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.93
Rate for Payer: Cigna Commercial	$23.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

INTEGRA WOUND DRSG 4X10CM

Facility

$2,651.00

Hospital Charge Code	270332610
Hospital Revenue Code	636
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$1,325.50
Rate for Payer: Aetna Commercial	$795.30
Rate for Payer: Aetna Medicare Advantage	$795.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$676.00
Rate for Payer: Cigna Commercial	$1,325.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.54
Rate for Payer: Qualcare PPO/HMO/WC	$397.65

INTEGRA WOUND DRSG 4X10CM

Facility

$2,651.00

Hospital Charge Code	270332610
Hospital Revenue Code	636
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$641.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.54
Rate for Payer: Qualcare PPO/HMO/WC	$397.65

INTEGRA WOUND MATRIX 2INx2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270686598
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

INTEGRA WOUND MATRIX 2INx2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270686598
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,187.00
Rate for Payer: Aetna Commercial	$2,187.00
Rate for Payer: Aetna Medicare Advantage	$2,187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,858.95
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

INTEGRA/X POR RED PROX 8MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680609
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/X POR RED PROX 8MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680609
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

INTEGRILIN 2MG/MLINJ100ML

Facility

$1,519.00

Hospital Charge Code	60635295
Hospital Revenue Code	636
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.60
Rate for Payer: Qualcare PPO/HMO/WC	$227.85

INTEGRILIN 2MG/MLINJ100ML

Facility

$1,519.00

Hospital Charge Code	60635295
Hospital Revenue Code	636
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$759.50
Rate for Payer: Aetna Commercial	$455.70
Rate for Payer: Aetna Medicare Advantage	$455.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$387.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$387.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$387.35
Rate for Payer: Cigna Commercial	$759.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.60
Rate for Payer: Qualcare PPO/HMO/WC	$227.85

INTEGRILIN 75MG/100ML INJ

Facility

$602.00

Hospital Charge Code	60635296
Hospital Revenue Code	636
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$145.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.68
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

Know your out-of-pocket cost for care.

All Charges