Heights University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX CONNECTOR 38-47MM SZ6

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691918
Hospital Revenue Code	278
Min. Negotiated Rate	$888.94
Max. Negotiated Rate	$2,963.12
Rate for Payer: Aetna Commercial	$1,777.88
Rate for Payer: Aetna Medicare Advantage	$1,777.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,511.19
Rate for Payer: Cigna Commercial	$2,963.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: Qualcare PPO/HMO/WC	$888.94

MATRIX CONNECTOR 38-47MM SZ6

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691918
Hospital Revenue Code	278
Min. Negotiated Rate	$888.94
Max. Negotiated Rate	$1,434.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: Qualcare PPO/HMO/WC	$888.94

MATRIX CONNECTOR # 5

Facility

$7,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270690701
Hospital Revenue Code	278
Min. Negotiated Rate	$1,095.00
Max. Negotiated Rate	$3,650.00
Rate for Payer: Aetna Commercial	$2,190.00
Rate for Payer: Aetna Medicare Advantage	$2,190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,861.50
Rate for Payer: Cigna Commercial	$3,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,095.00

MATRIX CONNECTOR # 5

Facility

$7,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270690701
Hospital Revenue Code	278
Min. Negotiated Rate	$1,095.00
Max. Negotiated Rate	$1,766.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,095.00

MATRIX DEMINERALIZED BONE PUTT

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270655826
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MATRIX DEMINERALIZED BONE PUTT

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270655826
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MATRIX FENESTRATED WOUND 3x

Facility

$755.00

Hospital Charge Code	270651180
Hospital Revenue Code	278
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$226.50
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.71
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

MATRIX FENESTRATED WOUND 3x

Facility

$755.00

Hospital Charge Code	270651180
Hospital Revenue Code	278
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$182.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.71
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

MATRIX FLWBLE WND 3CC/1CC JW

Facility

$6,525.00

Hospital Charge Code	270646968W
Hospital Revenue Code	636
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$1,579.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

MATRIX FLWBLE WND 3CC/1CC JW

Facility

$6,525.00

Hospital Charge Code	270646968W
Hospital Revenue Code	636
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$3,262.50
Rate for Payer: Aetna Commercial	$1,957.50
Rate for Payer: Aetna Medicare Advantage	$1,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.88
Rate for Payer: Cigna Commercial	$3,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

MATRIX FLWBLE WND 3cc FWD301

Facility

$16,350.00

Hospital Charge Code	270646968C
Hospital Revenue Code	272
Min. Negotiated Rate	$2,125.50
Max. Negotiated Rate	$8,175.00
Rate for Payer: Aetna Commercial	$4,905.00
Rate for Payer: Aetna Medicare Advantage	$4,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,169.25
Rate for Payer: Cigna Commercial	$8,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,125.50
Rate for Payer: Oxford Commercial	$8,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50
Rate for Payer: UnitedHealthcare Commercial	$8,175.00

MATRIX FLWBLE WND 3cc FWD301

Facility

$16,350.00

Hospital Charge Code	270646968C
Hospital Revenue Code	272
Min. Negotiated Rate	$2,452.50
Max. Negotiated Rate	$2,452.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50

MATRIX MICRONIZD PARTCLE 100mg

Facility

$1,504.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651181
Hospital Revenue Code	278
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$752.00
Rate for Payer: Aetna Commercial	$451.20
Rate for Payer: Aetna Medicare Advantage	$451.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.52
Rate for Payer: Cigna Commercial	$752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.97
Rate for Payer: Qualcare PPO/HMO/WC	$225.60

MATRIX MICRONIZD PARTCLE 100mg

Facility

$1,504.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651181
Hospital Revenue Code	278
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$363.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.97
Rate for Payer: Qualcare PPO/HMO/WC	$225.60

MATRIX MICRONIZD PARTCLE 50

Facility

$7,375.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651028
Hospital Revenue Code	636
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

MATRIX MICRONIZD PARTCLE 50

Facility

$7,375.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651028
Hospital Revenue Code	636
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,212.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

MATRIX MICRONIZED FINE 200 MG

Facility

$3,200.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651179
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$960.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

MATRIX MICRONIZED FINE 200 MG

Facility

$3,200.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651179
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

MATRIX PLASTIC PSMX0615

Facility

$13,500.00

Hospital Charge Code	270644125
Hospital Revenue Code	272
Min. Negotiated Rate	$1,755.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$6,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,750.00

MATRIX PLASTIC PSMX0615

Facility

$13,500.00

Hospital Charge Code	270644125
Hospital Revenue Code	272
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MATRIX PLASTIC PSMX1015

Facility

$15,750.00

Hospital Charge Code	270644127
Hospital Revenue Code	272
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$2,362.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

MATRIX PLASTIC PSMX1015

Facility

$15,750.00

Hospital Charge Code	270644127
Hospital Revenue Code	272
Min. Negotiated Rate	$2,047.50
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$4,725.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.50
Rate for Payer: Oxford Commercial	$7,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Commercial	$7,875.00

MATRIX PROTEIN

Facility

$15,000.00

Hospital Charge Code	270703297
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

MATRIX PROTEIN

Facility

$15,000.00

Hospital Charge Code	270703297
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

MATRIX STIMULAN RAP CURE 10CC

Facility

$8,975.00

Hospital Charge Code	270668279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$2,692.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

Know your out-of-pocket cost for care.

All Charges