Heights University Hospital

All Charges

Charge

Type

Setting

Price

MAGNUM 2 KNOTLESS IMPLANT

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270668401
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,537.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

MAGNUS V-CELLULAR ALLOGRFT 5CC

Facility

$13,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694686
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$4,192.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

MAGNUS V-CELLULAR ALLOGRFT 5CC

Facility

$13,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694686
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

MAG/NYST/LIDO VIS MAGIC MIX #9

Facility

$175.00

Hospital Charge Code	60629918
Hospital Revenue Code	250
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Oxford Commercial	$87.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$87.50

MAG/NYST/LIDO VIS MAGIC MIX #9

Facility

$175.00

Hospital Charge Code	60629918
Hospital Revenue Code	250
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

MAGONATE/1GM/5ML

Facility

$53.00

Hospital Charge Code	60633351
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

MAGONATE/1GM/5ML

Facility

$53.00

Hospital Charge Code	60633351
Hospital Revenue Code	250
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$15.90
Rate for Payer: Aetna Medicare Advantage	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.52
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.89
Rate for Payer: Oxford Commercial	$26.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Commercial	$26.50

MAGSEED IMG MARKER 18G 7CM

Facility

$2,981.55

Service Code	HCPCS A4648
Hospital Charge Code	270697617
Hospital Revenue Code	278
Min. Negotiated Rate	$447.23
Max. Negotiated Rate	$1,490.78
Rate for Payer: Aetna Commercial	$894.47
Rate for Payer: Aetna Medicare Advantage	$894.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$760.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$760.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$596.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$760.30
Rate for Payer: Cigna Commercial	$1,490.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.54
Rate for Payer: Qualcare PPO/HMO/WC	$447.23

MAGSEED IMG MARKER 18G 7CM

Facility

$2,981.55

Service Code	HCPCS A4648
Hospital Charge Code	270697617
Hospital Revenue Code	278
Min. Negotiated Rate	$447.23
Max. Negotiated Rate	$721.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$596.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.54
Rate for Payer: Qualcare PPO/HMO/WC	$447.23

MAG-SGPG AB (IGM)

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900527
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MAG-SGPG AB (IGM)

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900527
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

MAG SULFATE 1GM/2ML INJ 10 ML

Facility

$13.94

Service Code	HCPCS J3475
Hospital Charge Code	60627751
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.55
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

MAG SULFATE 1GM/2ML INJ 10 ML

Facility

$13.94

Service Code	HCPCS J3475
Hospital Charge Code	60627751
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$3.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

MAG SULFATE 8.12 MEQ/2 ML INJ

Facility

$9.65

Service Code	HCPCS J3475
Hospital Charge Code	6022669
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

MAG SULFATE 8.12 MEQ/2 ML INJ

Facility

$9.65

Service Code	HCPCS J3475
Hospital Charge Code	6022669
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

MAG,WESTERN BLOT W/RFX

Facility

$390.00

Service Code	HCPCS 84181
Hospital Charge Code	39900526
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MAG,WESTERN BLOT W/RFX

Facility

$390.00

Service Code	HCPCS 84181
Hospital Charge Code	39900526
Hospital Revenue Code	301
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

MAILMAN 300CM 3CN 1212001

Facility

$471.25

Hospital Charge Code	270636692
Hospital Revenue Code	278
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$235.62
Rate for Payer: Aetna Commercial	$141.38
Rate for Payer: Aetna Medicare Advantage	$141.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.17
Rate for Payer: Cigna Commercial	$235.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.04
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

MAILMAN 300CM 3CN 1212001

Facility

$471.25

Hospital Charge Code	270636692
Hospital Revenue Code	278
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$114.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.04
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

MAIN BODY AFX2 28 16 X 40 MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270684793
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$19,738.50
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

MAIN BODY AFX2 28 16 X 40 MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270684793
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

MAIN BODY TFB 28x74 Lg 279453

Facility

$36,704.00

Hospital Charge Code	270632725
Hospital Revenue Code	278
Min. Negotiated Rate	$5,505.60
Max. Negotiated Rate	$18,352.00
Rate for Payer: Aetna Commercial	$11,011.20
Rate for Payer: Aetna Medicare Advantage	$11,011.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,359.52
Rate for Payer: Cigna Commercial	$18,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60

MAIN BODY TFB 28x74 Lg 279453

Facility

$36,704.00

Hospital Charge Code	270632725
Hospital Revenue Code	278
Min. Negotiated Rate	$5,505.60
Max. Negotiated Rate	$8,882.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60

MAIN PUMP TUBING

Facility

$305.00

Hospital Charge Code	270688454
Hospital Revenue Code	272
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$45.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

MAIN PUMP TUBING

Facility

$305.00

Hospital Charge Code	270688454
Hospital Revenue Code	272
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$152.50
Rate for Payer: Aetna Commercial	$91.50
Rate for Payer: Aetna Medicare Advantage	$91.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.78
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.65
Rate for Payer: Oxford Commercial	$152.50
Rate for Payer: Qualcare PPO/HMO/WC	$45.75
Rate for Payer: UnitedHealthcare Commercial	$152.50

Know your out-of-pocket cost for care.

All Charges