Heights University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE TRANSGLUTAM(IGG,A) I

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071A
Hospital Revenue Code	301
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

TISSUE TRANSGLUTAM(IGG,A) I

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTAM(IGG,A) II

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071B
Hospital Revenue Code	301
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

TISSUE TRANSGLUTAM(IGG,A) II

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTAMINASE, IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476796
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMINASE, IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476796
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	$11.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479418
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479420
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479420
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	$11.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479418
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	$11.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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

TISSUE TRANSGLUTAMONASE, IGG

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476797
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMONASE, IGG

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476797
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	$11.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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

TISSUE TRANSGLUTAMONASE,IGG

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479419
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	$11.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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

TISSUE TRANSGLUTAMONASE,IGG

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479419
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTIMASE IGA

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900331
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTIMASE IGA

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900331
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

TISSUE TRAP SAFE TOUCH

Facility

$43.51

Hospital Charge Code	270652967
Hospital Revenue Code	272
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna Commercial	$13.05
Rate for Payer: Aetna Medicare Advantage	$13.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.10
Rate for Payer: Cigna Commercial	$21.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.75

TISSUE TRAP SAFE TOUCH

Facility

$43.51

Hospital Charge Code	270652967
Hospital Revenue Code	272
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

TISSUE TRX ADDL 30 SQ CM

Facility

$10,841.92

Service Code	HCPCS 14302
Hospital Charge Code	1600069
Hospital Revenue Code	360
Min. Negotiated Rate	$198.11
Max. Negotiated Rate	$3,252.58
Rate for Payer: Aetna Commercial	$3,252.58
Rate for Payer: Aetna Medicare Advantage	$3,252.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,764.69
Rate for Payer: Cigna Commercial	$198.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,409.45
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TISSUE TRX ADDL 30 SQ CM

Facility

$10,841.92

Service Code	HCPCS 14302
Hospital Charge Code	1600069
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.29
Max. Negotiated Rate	$1,626.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29

TISSUE TRX ADDL 30 SQ CM

Facility

$10,841.92

Service Code	HCPCS 14302
Hospital Charge Code	16000369
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.29
Max. Negotiated Rate	$1,626.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29

TISSUE TRX ADDL 30 SQ CM

Facility

$10,841.92

Service Code	HCPCS 14302
Hospital Charge Code	16000369
Hospital Revenue Code	360
Min. Negotiated Rate	$198.11
Max. Negotiated Rate	$3,252.58
Rate for Payer: Aetna Commercial	$3,252.58
Rate for Payer: Aetna Medicare Advantage	$3,252.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,764.69
Rate for Payer: Cigna Commercial	$198.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,409.45
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

TISSUE TRX ANY 30.1-60CM

Facility

$10,841.92

Service Code	HCPCS 14301
Hospital Charge Code	16000241
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.29
Max. Negotiated Rate	$1,626.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29

TISSUE TRX ANY 30.1-60CM

Facility

$10,841.92

Service Code	HCPCS 14301
Hospital Charge Code	16000241
Hospital Revenue Code	360
Min. Negotiated Rate	$1,409.45
Max. Negotiated Rate	$8,439.01
Rate for Payer: Aetna Commercial	$3,252.58
Rate for Payer: Aetna Medicare Advantage	$3,252.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,764.69
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,409.45
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

TISSUE TRX ANY 30.1-60CM

Facility

$10,841.92

Service Code	HCPCS 14301
Hospital Charge Code	5792297
Hospital Revenue Code	450
Min. Negotiated Rate	$924.39
Max. Negotiated Rate	$8,439.01
Rate for Payer: Aetna Commercial	$3,252.58
Rate for Payer: Aetna Medicare Advantage	$3,252.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,764.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$924.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,764.69
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,409.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,626.29

Know your out-of-pocket cost for care.

All Charges