Heights University Hospital

All Charges

Charge

Type

Setting

Price

TISS TRANSGLUTAMINASE IGG I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

TISS TRANSGLUTAMINASE IGG I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TISS TRANSGLUTAMINASE IGG II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TISS TRANSGLUTAMINASE IGG II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

TISS TRNSGLTMNASE EA IG CLASS

Facility

$115.30

Service Code	HCPCS 86364
Hospital Charge Code	401186364B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.30

TISS TRNSGLTMNASE EA IG CLASS

Facility

$115.30

Service Code	HCPCS 86364
Hospital Charge Code	401186364B
Hospital Revenue Code	302
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	$8.62
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	$14.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.30
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

TISSU CANCELL CUBES 20c 450488

Facility

$1,500.00

Hospital Charge Code	270638783
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

TISSU CANCELL CUBES 20c 450488

Facility

$1,500.00

Hospital Charge Code	270638783
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

TISSUE ATX TAK II 5 AR1935B30

Facility

$1,416.00

Hospital Charge Code	270622381
Hospital Revenue Code	272
Min. Negotiated Rate	$212.40
Max. Negotiated Rate	$212.40
Rate for Payer: Qualcare PPO/HMO/WC	$212.40

TISSUE ATX TAK II 5 AR1935B30

Facility

$1,416.00

Hospital Charge Code	270622381
Hospital Revenue Code	272
Min. Negotiated Rate	$184.08
Max. Negotiated Rate	$708.00
Rate for Payer: Aetna Commercial	$424.80
Rate for Payer: Aetna Medicare Advantage	$424.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.08
Rate for Payer: Cigna Commercial	$708.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.08
Rate for Payer: Oxford Commercial	$708.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.40
Rate for Payer: UnitedHealthcare Commercial	$708.00

TISSUE ATX TAK II 5 ST AR1935B

Facility

$2,832.00

Hospital Charge Code	270622380
Hospital Revenue Code	274
Min. Negotiated Rate	$424.80
Max. Negotiated Rate	$685.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$566.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$685.34
Rate for Payer: Qualcare PPO/HMO/WC	$424.80

TISSUE ATX TAK II 5 ST AR1935B

Facility

$2,832.00

Hospital Charge Code	270622380
Hospital Revenue Code	274
Min. Negotiated Rate	$424.80
Max. Negotiated Rate	$1,416.00
Rate for Payer: Aetna Commercial	$849.60
Rate for Payer: Aetna Medicare Advantage	$849.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$722.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$722.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$566.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$722.16
Rate for Payer: Cigna Commercial	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$685.34
Rate for Payer: Qualcare PPO/HMO/WC	$424.80

TISSUE AUGMENT 3 CC

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270678103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

TISSUE AUGMENT 3 CC

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270678103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$5,242.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

TISSUE BIOFIX FLOW PLACENT 1CC

Facility

$10,875.00

Service Code	HCPCS Q4114
Hospital Charge Code	270681641
Hospital Revenue Code	636
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

TISSUE BIOFIX FLOW PLACENT 1CC

Facility

$10,875.00

Service Code	HCPCS Q4114
Hospital Charge Code	270681641
Hospital Revenue Code	636
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$3,262.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

TISSUE CANCELLOUS 5/100MM MSL

Facility

$4,596.85

Hospital Charge Code	270608086
Hospital Revenue Code	278
Min. Negotiated Rate	$689.53
Max. Negotiated Rate	$1,112.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$919.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,112.44
Rate for Payer: Qualcare PPO/HMO/WC	$689.53

TISSUE CANCELLOUS 5/100MM MSL

Facility

$4,596.85

Hospital Charge Code	270608086
Hospital Revenue Code	278
Min. Negotiated Rate	$689.53
Max. Negotiated Rate	$2,298.43
Rate for Payer: Aetna Commercial	$1,379.06
Rate for Payer: Aetna Medicare Advantage	$1,379.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$919.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,172.20
Rate for Payer: Cigna Commercial	$2,298.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,112.44
Rate for Payer: Qualcare PPO/HMO/WC	$689.53

TISSUE CANCELLOUS CUBE 30CC

Facility

$2,681.65

Hospital Charge Code	270608089
Hospital Revenue Code	278
Min. Negotiated Rate	$402.25
Max. Negotiated Rate	$648.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.96
Rate for Payer: Qualcare PPO/HMO/WC	$402.25

TISSUE CANCELLOUS CUBE 30CC

Facility

$2,681.65

Hospital Charge Code	270608089
Hospital Revenue Code	278
Min. Negotiated Rate	$402.25
Max. Negotiated Rate	$1,340.83
Rate for Payer: Aetna Commercial	$804.50
Rate for Payer: Aetna Medicare Advantage	$804.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.82
Rate for Payer: Cigna Commercial	$1,340.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.96
Rate for Payer: Qualcare PPO/HMO/WC	$402.25

TISSUE CANCELLOUS CUBES 20ML

Facility

$1,665.00

Hospital Charge Code	270644806
Hospital Revenue Code	278
Min. Negotiated Rate	$249.75
Max. Negotiated Rate	$402.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.93
Rate for Payer: Qualcare PPO/HMO/WC	$249.75

TISSUE CANCELLOUS CUBES 20ML

Facility

$1,665.00

Hospital Charge Code	270644806
Hospital Revenue Code	278
Min. Negotiated Rate	$249.75
Max. Negotiated Rate	$832.50
Rate for Payer: Aetna Commercial	$499.50
Rate for Payer: Aetna Medicare Advantage	$499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$424.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$424.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$424.57
Rate for Payer: Cigna Commercial	$832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.93
Rate for Payer: Qualcare PPO/HMO/WC	$249.75

TISSUE CLARIX COR 1K 1.5x1.5cm

Facility

$5,975.00

Service Code	HCPCS Q4100
Hospital Charge Code	270679120
Hospital Revenue Code	636
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$1,792.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

TISSUE CLARIX COR 1K 1.5x1.5cm

Facility

$5,975.00

Service Code	HCPCS Q4100
Hospital Charge Code	270679120
Hospital Revenue Code	636
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

TISSUE CORNEA

Facility

$4,569.65

Hospital Charge Code	270608603
Hospital Revenue Code	278
Min. Negotiated Rate	$685.45
Max. Negotiated Rate	$1,105.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.86
Rate for Payer: Qualcare PPO/HMO/WC	$685.45

Know your out-of-pocket cost for care.

All Charges