Heights University Hospital

All Charges

Charge

Type

Setting

Price

MESH PHASIX ROUND 3IN 7.6CM

Facility

$7,324.00

Service Code	HCPCS C1781
Hospital Charge Code	270697134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,098.60
Max. Negotiated Rate	$3,662.00
Rate for Payer: Aetna Commercial	$2,197.20
Rate for Payer: Aetna Medicare Advantage	$2,197.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,867.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,867.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,464.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,867.62
Rate for Payer: Cigna Commercial	$3,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,772.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,098.60

MESH PHASIX ROUND 4IN 11CM

Facility

$13,755.00

Service Code	HCPCS C1781
Hospital Charge Code	270697135
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.25
Max. Negotiated Rate	$6,877.50
Rate for Payer: Aetna Commercial	$4,126.50
Rate for Payer: Aetna Medicare Advantage	$4,126.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,507.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,507.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,507.53
Rate for Payer: Cigna Commercial	$6,877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.25

MESH PHASIX ROUND 4IN 11CM

Facility

$13,755.00

Service Code	HCPCS C1781
Hospital Charge Code	270697135
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.25
Max. Negotiated Rate	$3,328.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.25

MESH PHASIX ST 20 X 25

Facility

$58,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270687051
Hospital Revenue Code	278
Min. Negotiated Rate	$8,700.00
Max. Negotiated Rate	$14,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,036.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,700.00

MESH PHASIX ST 20 X 25

Facility

$58,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270687051
Hospital Revenue Code	278
Min. Negotiated Rate	$8,700.00
Max. Negotiated Rate	$29,000.00
Rate for Payer: Aetna Commercial	$17,400.00
Rate for Payer: Aetna Medicare Advantage	$17,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,790.00
Rate for Payer: Cigna Commercial	$29,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,036.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,700.00

MESH PHASIX ST 30X35 MM

Facility

$124,915.00

Service Code	HCPCS C1781
Hospital Charge Code	270694006
Hospital Revenue Code	278
Min. Negotiated Rate	$18,737.25
Max. Negotiated Rate	$30,229.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,983.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30,229.43
Rate for Payer: Qualcare PPO/HMO/WC	$18,737.25

MESH PHASIX ST 30X35 MM

Facility

$124,915.00

Service Code	HCPCS C1781
Hospital Charge Code	270694006
Hospital Revenue Code	278
Min. Negotiated Rate	$18,737.25
Max. Negotiated Rate	$62,457.50
Rate for Payer: Aetna Commercial	$37,474.50
Rate for Payer: Aetna Medicare Advantage	$37,474.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,853.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,853.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,853.33
Rate for Payer: Cigna Commercial	$62,457.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30,229.43
Rate for Payer: Qualcare PPO/HMO/WC	$18,737.25

MESH PHASIX ST 6X6

Facility

$41,900.00

Service Code	HCPCS C1781
Hospital Charge Code	270693817
Hospital Revenue Code	278
Min. Negotiated Rate	$6,285.00
Max. Negotiated Rate	$20,950.00
Rate for Payer: Aetna Commercial	$12,570.00
Rate for Payer: Aetna Medicare Advantage	$12,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,684.50
Rate for Payer: Cigna Commercial	$20,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,139.80
Rate for Payer: Qualcare PPO/HMO/WC	$6,285.00

MESH PHASIX ST 6X6

Facility

$41,900.00

Service Code	HCPCS C1781
Hospital Charge Code	270693817
Hospital Revenue Code	278
Min. Negotiated Rate	$6,285.00
Max. Negotiated Rate	$10,139.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,139.80
Rate for Payer: Qualcare PPO/HMO/WC	$6,285.00

MESH PHASIX ST WITH ECHO2

Facility

$50,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270698101
Hospital Revenue Code	278
Min. Negotiated Rate	$7,500.00
Max. Negotiated Rate	$25,000.00
Rate for Payer: Aetna Commercial	$15,000.00
Rate for Payer: Aetna Medicare Advantage	$15,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,750.00
Rate for Payer: Cigna Commercial	$25,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,500.00

MESH PHASIX ST WITH ECHO2

Facility

$50,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270698101
Hospital Revenue Code	278
Min. Negotiated Rate	$7,500.00
Max. Negotiated Rate	$12,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,500.00

MESH PLUG LG

Facility

$1,775.00

Hospital Charge Code	270699486
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$887.50
Rate for Payer: Aetna Commercial	$532.50
Rate for Payer: Aetna Medicare Advantage	$532.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.62
Rate for Payer: Cigna Commercial	$887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

MESH PLUG LG

Facility

$1,775.00

Hospital Charge Code	270699486
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$429.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

MESHPLUGMARLEXPERFIX2.5X3.4CM

Facility

$1,402.50

Service Code	HCPCS C1781
Hospital Charge Code	270657649
Hospital Revenue Code	278
Min. Negotiated Rate	$210.38
Max. Negotiated Rate	$701.25
Rate for Payer: Aetna Commercial	$420.75
Rate for Payer: Aetna Medicare Advantage	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.64
Rate for Payer: Cigna Commercial	$701.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.40
Rate for Payer: Qualcare PPO/HMO/WC	$210.38

MESHPLUGMARLEXPERFIX2.5X3.4CM

Facility

$1,402.50

Service Code	HCPCS C1781
Hospital Charge Code	270657649
Hospital Revenue Code	278
Min. Negotiated Rate	$210.38
Max. Negotiated Rate	$339.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.40
Rate for Payer: Qualcare PPO/HMO/WC	$210.38

MESH PLUG PROLOOP MED

Facility

$1,244.60

Hospital Charge Code	270655386
Hospital Revenue Code	278
Min. Negotiated Rate	$186.69
Max. Negotiated Rate	$622.30
Rate for Payer: Aetna Commercial	$373.38
Rate for Payer: Aetna Medicare Advantage	$373.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$317.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$317.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$317.37
Rate for Payer: Cigna Commercial	$622.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.19
Rate for Payer: Qualcare PPO/HMO/WC	$186.69

MESH PLUG PROLOOP MED

Facility

$1,244.60

Hospital Charge Code	270655386
Hospital Revenue Code	278
Min. Negotiated Rate	$186.69
Max. Negotiated Rate	$301.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.19
Rate for Payer: Qualcare PPO/HMO/WC	$186.69

MESH PLUG ULTRAPRO LG 5CM

Facility

$898.65

Service Code	HCPCS C1781
Hospital Charge Code	270698947
Hospital Revenue Code	278
Min. Negotiated Rate	$134.80
Max. Negotiated Rate	$449.32
Rate for Payer: Aetna Commercial	$269.60
Rate for Payer: Aetna Medicare Advantage	$269.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.16
Rate for Payer: Cigna Commercial	$449.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.47
Rate for Payer: Qualcare PPO/HMO/WC	$134.80

MESH PLUG ULTRAPRO LG 5CM

Facility

$898.65

Service Code	HCPCS C1781
Hospital Charge Code	270698947
Hospital Revenue Code	278
Min. Negotiated Rate	$134.80
Max. Negotiated Rate	$217.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.47
Rate for Payer: Qualcare PPO/HMO/WC	$134.80

MESH PLUG ULTRAPRO MEDIUM 4CM

Facility

$889.85

Service Code	HCPCS C1781
Hospital Charge Code	270698946
Hospital Revenue Code	278
Min. Negotiated Rate	$133.48
Max. Negotiated Rate	$215.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.34
Rate for Payer: Qualcare PPO/HMO/WC	$133.48

MESH PLUG ULTRAPRO MEDIUM 4CM

Facility

$889.85

Service Code	HCPCS C1781
Hospital Charge Code	270698946
Hospital Revenue Code	278
Min. Negotiated Rate	$133.48
Max. Negotiated Rate	$444.93
Rate for Payer: Aetna Commercial	$266.95
Rate for Payer: Aetna Medicare Advantage	$266.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.91
Rate for Payer: Cigna Commercial	$444.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.34
Rate for Payer: Qualcare PPO/HMO/WC	$133.48

MESH POUCH PET THREAD 20x25MM

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270674905
Hospital Revenue Code	278
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$9,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

MESH POUCH PET THREAD 20x25MM

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270674905
Hospital Revenue Code	278
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

MESH PRE-CONTOURED 163 X 115MM

Facility

$22,135.00

Hospital Charge Code	270663409
Hospital Revenue Code	278
Min. Negotiated Rate	$3,320.25
Max. Negotiated Rate	$5,356.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,427.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,356.67
Rate for Payer: Qualcare PPO/HMO/WC	$3,320.25

MESH PRE-CONTOURED 163 X 115MM

Facility

$22,135.00

Hospital Charge Code	270663409
Hospital Revenue Code	278
Min. Negotiated Rate	$3,320.25
Max. Negotiated Rate	$11,067.50
Rate for Payer: Aetna Commercial	$6,640.50
Rate for Payer: Aetna Medicare Advantage	$6,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,644.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,644.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,427.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,644.43
Rate for Payer: Cigna Commercial	$11,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,356.67
Rate for Payer: Qualcare PPO/HMO/WC	$3,320.25

Know your out-of-pocket cost for care.

All Charges