Heights University Hospital

All Charges

Charge

Type

Setting

Price

THERAGENESISBILAYMATRIX40X60MM

Facility

$7,750.00

Service Code	HCPCS A2008
Hospital Charge Code	270694307
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,325.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

THERAGENESIS BILAYMATRIX 4X6CM

Facility

$8,750.00

Service Code	HCPCS A2008
Hospital Charge Code	270695638
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

THERAGENESIS BILAYMATRIX 4X6CM

Facility

$8,750.00

Service Code	HCPCS A2008
Hospital Charge Code	270695638
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

THERAGENESISBILAYMATRIX82X60MM

Facility

$10,000.00

Service Code	HCPCS A2008
Hospital Charge Code	270694172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

THERAGENESISBILAYMATRIX82X60MM

Facility

$10,000.00

Service Code	HCPCS A2008
Hospital Charge Code	270694172
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

THERAGENSISBILAYDMATR200X240MM

Facility

$39,750.00

Service Code	HCPCS A2008
Hospital Charge Code	270697670
Hospital Revenue Code	278
Min. Negotiated Rate	$5,962.50
Max. Negotiated Rate	$9,619.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,619.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,962.50

THERAGENSISBILAYDMATR200X240MM

Facility

$39,750.00

Service Code	HCPCS A2008
Hospital Charge Code	270697670
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$11,925.00
Rate for Payer: Aetna Commercial	$11,925.00
Rate for Payer: Aetna Medicare Advantage	$11,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,136.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,136.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,136.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,619.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,962.50

THERAGENSISBILAYDMATRIX12X24

Facility

$26,500.00

Service Code	HCPCS A2008
Hospital Charge Code	270697008
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$7,950.00
Rate for Payer: Aetna Commercial	$7,950.00
Rate for Payer: Aetna Medicare Advantage	$7,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,757.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,413.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,975.00

THERAGENSISBILAYDMATRIX12X24

Facility

$26,500.00

Service Code	HCPCS A2008
Hospital Charge Code	270697008
Hospital Revenue Code	278
Min. Negotiated Rate	$3,975.00
Max. Negotiated Rate	$6,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,413.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,975.00

THERAGENSISBILAYMATRIX8X9CM

Facility

$12,500.00

Service Code	HCPCS A2008
Hospital Charge Code	270695639
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

THERAGENSISBILAYMATRIX8X9CM

Facility

$12,500.00

Service Code	HCPCS A2008
Hospital Charge Code	270695639
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$3,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

THERAGRAN HEMATINIC/TAB

Facility

$1.00

Hospital Charge Code	60634010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

THERAGRAN HEMATINIC/TAB

Facility

$1.00

Hospital Charge Code	60634010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

THERAGRAN-M/TAB

Facility

$1.00

Hospital Charge Code	60634012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

THERAGRAN-M/TAB

Facility

$1.00

Hospital Charge Code	60634012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

THERAGRAN-M/TAB

Facility

$1.00

Hospital Charge Code	60634011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

THERAGRAN-M/TAB

Facility

$1.00

Hospital Charge Code	60634011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

THERAPEUTIC ACT EA 15 MIN CQ

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	409197530Q
Hospital Revenue Code	420
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

THERAPEUTIC ACT EA 15 MIN CQ

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	409197530Q
Hospital Revenue Code	420
Min. Negotiated Rate	$31.79
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.35
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.79
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$686.00

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GP
Hospital Charge Code	1008300
Hospital Revenue Code	420
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.50
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.85
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$686.00

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008290
Hospital Revenue Code	430
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.50
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.85
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$686.00

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GP
Hospital Charge Code	1008300
Hospital Revenue Code	420
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008290
Hospital Revenue Code	430
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

THERAPEUTIC APHERESIS

Facility

$7,167.00

Service Code	HCPCS 36520
Hospital Charge Code	3100015
Hospital Revenue Code	386
Min. Negotiated Rate	$1,075.05
Max. Negotiated Rate	$1,075.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.05

THERAPEUTIC APHERESIS

Facility

$7,167.00

Service Code	HCPCS 36520
Hospital Charge Code	3100015
Hospital Revenue Code	386
Min. Negotiated Rate	$666.00
Max. Negotiated Rate	$3,583.50
Rate for Payer: Aetna Commercial	$2,150.10
Rate for Payer: Aetna Medicare Advantage	$2,150.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,827.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,827.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,827.59
Rate for Payer: Cigna Commercial	$3,583.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.71
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.05
Rate for Payer: UnitedHealthcare Commercial	$756.00

Know your out-of-pocket cost for care.

All Charges