Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRODISC C VIVO 15X14MM H6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704586
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 17X14MM H5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704629
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$8,925.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 17X14MM H5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704629
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 17X14X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705157
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$8,925.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 17X14X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705157
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 7X16MM H5MM

Facility

$29,750.00

Hospital Charge Code	270702660
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 7X16MM H5MM

Facility

$29,750.00

Hospital Charge Code	270702660
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$8,925.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C VIVO LD 17X16X6MM

Facility

$42,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698968
Hospital Revenue Code	278
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$10,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00

PRODISC-C VIVO LD 17X16X6MM

Facility

$42,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698968
Hospital Revenue Code	278
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$21,250.00
Rate for Payer: Aetna Commercial	$12,750.00
Rate for Payer: Aetna Medicare Advantage	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,837.50
Rate for Payer: Cigna Commercial	$21,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00

PRODISC C VIVO REPLACE MED 5MM

Facility

$42,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697981
Hospital Revenue Code	278
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$21,250.00
Rate for Payer: Aetna Commercial	$12,750.00
Rate for Payer: Aetna Medicare Advantage	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,837.50
Rate for Payer: Cigna Commercial	$21,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00

PRODISC C VIVO REPLACE MED 5MM

Facility

$42,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697981
Hospital Revenue Code	278
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$10,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00

PRODISC L, INFER. ENDPLATE M,

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270706001
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.00
Max. Negotiated Rate	$13,760.00
Rate for Payer: Aetna Commercial	$8,256.00
Rate for Payer: Aetna Medicare Advantage	$8,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,017.60
Rate for Payer: Cigna Commercial	$13,760.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00

PRODISC L, INFER. ENDPLATE M,

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270706001
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.00
Max. Negotiated Rate	$6,659.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00

PRODISC L, PE INLAY M, 10MM

Facility

$11,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270706000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.00
Max. Negotiated Rate	$2,812.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,812.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.00

PRODISC L, PE INLAY M, 10MM

Facility

$11,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270706000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.00
Max. Negotiated Rate	$5,810.00
Rate for Payer: Aetna Commercial	$3,486.00
Rate for Payer: Aetna Medicare Advantage	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,963.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,963.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,963.10
Rate for Payer: Cigna Commercial	$5,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,812.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.00

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,087.50
Max. Negotiated Rate	$6,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	27705999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.00
Max. Negotiated Rate	$13,760.00
Rate for Payer: Aetna Commercial	$8,256.00
Rate for Payer: Aetna Medicare Advantage	$8,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,017.60
Rate for Payer: Cigna Commercial	$13,760.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,087.50
Max. Negotiated Rate	$13,625.00
Rate for Payer: Aetna Commercial	$8,175.00
Rate for Payer: Aetna Medicare Advantage	$8,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,948.75
Rate for Payer: Cigna Commercial	$13,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	27705999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.00
Max. Negotiated Rate	$6,659.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00

PRODUCT AUTOLOG PACKED CELLS

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100286
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

PRODUCT AUTOLOG PACKED CELLS

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100286
Hospital Revenue Code	300
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PRODUCT CRYOPRECIPITATES

Facility

$142.10

Hospital Charge Code	3100104
Hospital Revenue Code	390
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$21.32
Rate for Payer: Qualcare PPO/HMO/WC	$21.32

PRODUCT CRYOPRECIPITATES

Facility

$142.10

Hospital Charge Code	3100104
Hospital Revenue Code	390
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$42.63
Rate for Payer: Aetna Medicare Advantage	$42.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$71.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.47
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.32
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT DIRECT DONOR FFP

Facility

$203.55

Hospital Charge Code	3100377
Hospital Revenue Code	390
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$61.06
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.46
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT DIRECT DONOR FFP

Facility

$203.55

Hospital Charge Code	3100377
Hospital Revenue Code	390
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

Know your out-of-pocket cost for care.

All Charges