Heights University Hospital

All Charges

Charge

Type

Setting

Price

TISSEAL FIBRIN SEALANT

Facility

$1,031.95

Hospital Charge Code	270660608
Hospital Revenue Code	272
Min. Negotiated Rate	$134.15
Max. Negotiated Rate	$515.98
Rate for Payer: Aetna Commercial	$309.58
Rate for Payer: Aetna Medicare Advantage	$309.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.15
Rate for Payer: Cigna Commercial	$515.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.15
Rate for Payer: Oxford Commercial	$515.98
Rate for Payer: Qualcare PPO/HMO/WC	$154.79
Rate for Payer: UnitedHealthcare Commercial	$515.98

TISSEEL 10ML FROZEN RTU

Facility

$2,350.65

Service Code	HCPCS C9250
Hospital Charge Code	270662413
Hospital Revenue Code	636
Min. Negotiated Rate	$352.60
Max. Negotiated Rate	$705.20
Rate for Payer: Aetna Commercial	$705.20
Rate for Payer: Aetna Medicare Advantage	$705.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.86
Rate for Payer: Qualcare PPO/HMO/WC	$352.60

TISSEEL 10ML FROZEN RTU

Facility

$957.85

Service Code	HCPCS C9250
Hospital Charge Code	270662412
Hospital Revenue Code	636
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$287.36
Rate for Payer: Aetna Commercial	$287.36
Rate for Payer: Aetna Medicare Advantage	$287.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.68

TISSEEL 10ML FROZEN RTU

Facility

$957.85

Service Code	HCPCS C9250
Hospital Charge Code	270662412
Hospital Revenue Code	636
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$231.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.68

TISSEEL 10ML FROZEN RTU

Facility

$2,350.65

Service Code	HCPCS C9250
Hospital Charge Code	270662413
Hospital Revenue Code	636
Min. Negotiated Rate	$352.60
Max. Negotiated Rate	$568.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.86
Rate for Payer: Qualcare PPO/HMO/WC	$352.60

TISSEEL 2ML FROZEN RTU

Facility

$571.45

Service Code	HCPCS C9250
Hospital Charge Code	270662411
Hospital Revenue Code	636
Min. Negotiated Rate	$85.72
Max. Negotiated Rate	$171.44
Rate for Payer: Aetna Commercial	$171.44
Rate for Payer: Aetna Medicare Advantage	$171.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.29
Rate for Payer: Qualcare PPO/HMO/WC	$85.72

TISSEEL 2ML FROZEN RTU

Facility

$571.45

Service Code	HCPCS C9250
Hospital Charge Code	270662411
Hospital Revenue Code	636
Min. Negotiated Rate	$85.72
Max. Negotiated Rate	$138.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.29
Rate for Payer: Qualcare PPO/HMO/WC	$85.72

TISSEEL 4ML FROZEN PRIMA

Facility

$986.60

Service Code	HCPCS C9250
Hospital Charge Code	270687687
Hospital Revenue Code	636
Min. Negotiated Rate	$147.99
Max. Negotiated Rate	$238.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.76
Rate for Payer: Qualcare PPO/HMO/WC	$147.99

TISSEEL 4ML FROZEN PRIMA

Facility

$986.60

Service Code	HCPCS C9250
Hospital Charge Code	270687687
Hospital Revenue Code	636
Min. Negotiated Rate	$147.99
Max. Negotiated Rate	$295.98
Rate for Payer: Aetna Commercial	$295.98
Rate for Payer: Aetna Medicare Advantage	$295.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.76
Rate for Payer: Qualcare PPO/HMO/WC	$147.99

TISSEEL FIBRIN SEALANT

Facility

$600.95

Service Code	HCPCS C9250
Hospital Charge Code	270653751
Hospital Revenue Code	636
Min. Negotiated Rate	$90.14
Max. Negotiated Rate	$180.28
Rate for Payer: Aetna Commercial	$180.28
Rate for Payer: Aetna Medicare Advantage	$180.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.14

TISSEEL FIBRIN SEALANT

Facility

$600.95

Service Code	HCPCS C9250
Hospital Charge Code	270653751
Hospital Revenue Code	636
Min. Negotiated Rate	$90.14
Max. Negotiated Rate	$145.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.14

TISSEEL KIT 4ML

Facility

$516.64

Service Code	NDC 338840204
Hospital Charge Code	606361017
Hospital Revenue Code	250
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Qualcare PPO/HMO/WC	$77.50

TISSEEL KIT 4ML

Facility

$516.64

Service Code	NDC 338840204
Hospital Charge Code	606361017
Hospital Revenue Code	250
Min. Negotiated Rate	$67.16
Max. Negotiated Rate	$258.32
Rate for Payer: Aetna Commercial	$154.99
Rate for Payer: Aetna Medicare Advantage	$154.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.74
Rate for Payer: Cigna Commercial	$258.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.16
Rate for Payer: Oxford Commercial	$258.32
Rate for Payer: Qualcare PPO/HMO/WC	$77.50
Rate for Payer: UnitedHealthcare Commercial	$258.32

TISSEEL VHSD FROZEN PRIMA 2ML

Facility

$606.25

Hospital Charge Code	270687686
Hospital Revenue Code	272
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$303.12
Rate for Payer: Aetna Commercial	$181.88
Rate for Payer: Aetna Medicare Advantage	$181.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.59
Rate for Payer: Cigna Commercial	$303.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.81
Rate for Payer: Oxford Commercial	$303.12
Rate for Payer: Qualcare PPO/HMO/WC	$90.94
Rate for Payer: UnitedHealthcare Commercial	$303.12

TISSEEL VHSD FROZEN PRIMA 2ML

Facility

$606.25

Hospital Charge Code	270687686
Hospital Revenue Code	272
Min. Negotiated Rate	$90.94
Max. Negotiated Rate	$90.94
Rate for Payer: Qualcare PPO/HMO/WC	$90.94

TISSEEL VHSD FROZEN PRIMA 8ML

Facility

$2,421.17

Service Code	HCPCS A4649
Hospital Charge Code	270687688
Hospital Revenue Code	272
Min. Negotiated Rate	$363.18
Max. Negotiated Rate	$363.18
Rate for Payer: Qualcare PPO/HMO/WC	$363.18

TISSEEL VHSD FROZEN PRIMA 8ML

Facility

$2,421.17

Service Code	HCPCS A4649
Hospital Charge Code	270687688
Hospital Revenue Code	272
Min. Negotiated Rate	$314.75
Max. Negotiated Rate	$1,210.59
Rate for Payer: Aetna Commercial	$726.35
Rate for Payer: Aetna Medicare Advantage	$726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.40
Rate for Payer: Cigna Commercial	$1,210.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.75
Rate for Payer: Oxford Commercial	$1,210.59
Rate for Payer: Qualcare PPO/HMO/WC	$363.18
Rate for Payer: UnitedHealthcare Commercial	$1,210.59

TISS MATRX FIRM 20x25CM

Facility

$83,055.00

Hospital Charge Code	270661025
Hospital Revenue Code	636
Min. Negotiated Rate	$12,458.25
Max. Negotiated Rate	$20,099.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,099.31
Rate for Payer: Qualcare PPO/HMO/WC	$12,458.25

TISS MATRX FIRM 20x25CM

Facility

$83,055.00

Hospital Charge Code	270661025
Hospital Revenue Code	636
Min. Negotiated Rate	$12,458.25
Max. Negotiated Rate	$41,527.50
Rate for Payer: Aetna Commercial	$24,916.50
Rate for Payer: Aetna Medicare Advantage	$24,916.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,179.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,179.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,179.03
Rate for Payer: Cigna Commercial	$41,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,099.31
Rate for Payer: Qualcare PPO/HMO/WC	$12,458.25

TISS MATRX FIRM 20x25CM/SQCMJW

Facility

$166.11

Hospital Charge Code	270661025W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.92

TISS MATRX FIRM 20x25CM/SQCMJW

Facility

$166.11

Hospital Charge Code	270661025W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$83.06
Rate for Payer: Aetna Commercial	$49.83
Rate for Payer: Aetna Medicare Advantage	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.36
Rate for Payer: Cigna Commercial	$83.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.92

TISS THROMBOPLASTIN INH T

Facility

$51.80

Service Code	HCPCS 85705
Hospital Charge Code	39900185
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$7.77
Rate for Payer: Qualcare PPO/HMO/WC	$7.77

TISS THROMBOPLASTIN INH T

Facility

$51.80

Service Code	HCPCS 85705
Hospital Charge Code	39900185
Hospital Revenue Code	305
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.28
Rate for Payer: Cigna Commercial	$9.63
Rate for Payer: Cigna Medicare Advantage	$4.82
Rate for Payer: Clover Medicare Advantage	$9.15
Rate for Payer: EmblemHealth Commercial	$28.89
Rate for Payer: Humana Medicare Advantage	$9.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.21
Rate for Payer: Wellcare Medicare Advantage	$9.63

TISS TRANSGLUTAMINASE IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39990009EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISS TRANSGLUTAMINASE IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39990009EX
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
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	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

Know your out-of-pocket cost for care.

All Charges