Heights University Hospital

All Charges

Charge

Type

Setting

Price

AUTOCHONDROCYTE IMPLANT KNEE

Facility

$22,425.68

Service Code	HCPCS 27412
Hospital Charge Code	16000885
Hospital Revenue Code	360
Min. Negotiated Rate	$3,363.85
Max. Negotiated Rate	$3,363.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,363.85

AUTOINJECTOR 2

Facility

$5,300.00

Hospital Charge Code	270690552
Hospital Revenue Code	270
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$795.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

AUTOINJECTOR 2

Facility

$5,300.00

Hospital Charge Code	270690552
Hospital Revenue Code	270
Min. Negotiated Rate	$689.00
Max. Negotiated Rate	$2,650.00
Rate for Payer: Aetna Commercial	$1,590.00
Rate for Payer: Aetna Medicare Advantage	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,351.50
Rate for Payer: Cigna Commercial	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.00
Rate for Payer: Oxford Commercial	$2,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00
Rate for Payer: UnitedHealthcare Commercial	$2,650.00

AUTOINJECTOR O-PRIME PMA

Facility

$1,250.00

Hospital Charge Code	270677358
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

AUTOINJECTOR O-PRIME PMA

Facility

$1,250.00

Hospital Charge Code	270677358
Hospital Revenue Code	272
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

AUTOLOGOUS BLOOD EA UNIT

Facility

$296.00

Service Code	HCPCS 86890
Hospital Charge Code	38471083
Hospital Revenue Code	309
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$88.80
Rate for Payer: Aetna Medicare Advantage	$88.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.48
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

AUTOLOGOUS BLOOD EA UNIT

Facility

$296.00

Service Code	HCPCS 86890
Hospital Charge Code	38471083
Hospital Revenue Code	309
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$51,111.05

Service Code	APR-DRG 0082
Min. Negotiated Rate	$50,108.87
Max. Negotiated Rate	$51,111.05
Rate for Payer: Aetna Better Health Medicaid	$50,108.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,111.05

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$31,761.49

Service Code	APR-DRG 0081
Min. Negotiated Rate	$31,138.72
Max. Negotiated Rate	$31,761.49
Rate for Payer: Aetna Better Health Medicaid	$31,138.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,761.49

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$102,101.33

Service Code	APR-DRG 0084
Min. Negotiated Rate	$100,099.34
Max. Negotiated Rate	$102,101.33
Rate for Payer: Aetna Better Health Medicaid	$100,099.34
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$102,101.33

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$61,187.47

Service Code	APR-DRG 0083
Min. Negotiated Rate	$59,987.72
Max. Negotiated Rate	$61,187.47
Rate for Payer: Aetna Better Health Medicaid	$59,987.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$61,187.47

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$199,948.77

Service Code	MSDRG 016
Min. Negotiated Rate	$58,246.45
Max. Negotiated Rate	$199,948.77
Rate for Payer: Aetna Commercial	$199,948.77
Rate for Payer: Aetna Medicare Advantage	$64,708.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170,364.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170,364.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61,312.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170,364.06
Rate for Payer: Cigna Medicare Advantage	$61,312.05
Rate for Payer: Clover Medicare Advantage	$58,246.45
Rate for Payer: EmblemHealth Commercial	$183,936.15
Rate for Payer: Humana Medicare Advantage	$63,151.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$61,312.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$64,990.77
Rate for Payer: Wellcare Medicare Advantage	$61,312.05

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$183,176.50

Service Code	MSDRG 017
Min. Negotiated Rate	$53,674.60
Max. Negotiated Rate	$183,176.50
Rate for Payer: Aetna Commercial	$183,176.50
Rate for Payer: Aetna Medicare Advantage	$59,280.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170,364.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170,364.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$56,499.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170,364.06
Rate for Payer: Cigna Medicare Advantage	$56,499.58
Rate for Payer: Clover Medicare Advantage	$53,674.60
Rate for Payer: EmblemHealth Commercial	$169,498.74
Rate for Payer: Humana Medicare Advantage	$58,194.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$56,499.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$59,889.55
Rate for Payer: Wellcare Medicare Advantage	$56,499.58

AUTOLOGOUS FIBRIN PLATELET SYS

Facility

$17,500.00

Hospital Charge Code	270670729
Hospital Revenue Code	272
Min. Negotiated Rate	$2,275.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,275.00
Rate for Payer: Oxford Commercial	$8,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Commercial	$8,750.00

AUTOLOGOUS FIBRIN PLATELET SYS

Facility

$17,500.00

Hospital Charge Code	270670729
Hospital Revenue Code	272
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

AUTOLOGOUS FRESH FROZEN PLASMA

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100948
Hospital Revenue Code	300
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

AUTOLOGOUS FRESH FROZEN PLASMA

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100948
Hospital Revenue Code	300
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$1,918.64
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.42
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

AUTOLOGOUS PLATELET SYSTEM 60M

Facility

$6,975.00

Service Code	HCPCS A4649
Hospital Charge Code	270696437
Hospital Revenue Code	272
Min. Negotiated Rate	$906.75
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,092.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.75
Rate for Payer: Oxford Commercial	$3,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$3,487.50

AUTOLOGOUS PLATELET SYSTEM 60M

Facility

$6,975.00

Service Code	HCPCS A4649
Hospital Charge Code	270696437
Hospital Revenue Code	272
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

AUTOLOGOUS PREDEPOSIT DONOR

Facility

$452.85

Service Code	HCPCS 86890
Hospital Charge Code	3100146
Hospital Revenue Code	300
Min. Negotiated Rate	$56.19
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$135.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.48
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.93
Rate for Payer: UnitedHealthcare Commercial	$114.00

AUTOLOGOUS PREDEPOSIT DONOR

Facility

$452.85

Service Code	HCPCS 86890
Hospital Charge Code	3100146
Hospital Revenue Code	300
Min. Negotiated Rate	$67.93
Max. Negotiated Rate	$67.93
Rate for Payer: Qualcare PPO/HMO/WC	$67.93

AUTOLOGOUS TRANSFUSION UP TO 4

Facility

$2,492.00

Service Code	HCPCS 86891
Hospital Charge Code	38470100
Hospital Revenue Code	309
Min. Negotiated Rate	$79.12
Max. Negotiated Rate	$1,918.64
Rate for Payer: Aetna Commercial	$747.60
Rate for Payer: Aetna Medicare Advantage	$747.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.46
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$323.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$373.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

AUTOLOGOUS TRANSFUSION UP TO 4

Facility

$2,492.00

Service Code	HCPCS 86891
Hospital Charge Code	38470100
Hospital Revenue Code	309
Min. Negotiated Rate	$373.80
Max. Negotiated Rate	$373.80
Rate for Payer: Qualcare PPO/HMO/WC	$373.80

AUTOLOGOUS WHOLE BLD

Facility

$419.85

Hospital Charge Code	3100013
Hospital Revenue Code	390
Min. Negotiated Rate	$54.58
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$125.95
Rate for Payer: Aetna Medicare Advantage	$125.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.06
Rate for Payer: Cigna Commercial	$209.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.58
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$756.00

AUTOLOGOUS WHOLE BLD

Facility

$419.85

Hospital Charge Code	3100013
Hospital Revenue Code	390
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

Know your out-of-pocket cost for care.

All Charges