Heights University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE EXPANDER HI PRO 750CC

Facility

$10,625.00

Service Code	HCPCS C1789
Hospital Charge Code	270675148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 750CC

Facility

$10,625.00

Service Code	HCPCS C1789
Hospital Charge Code	270675148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$3,187.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER MATRIX 500CC

Facility

$7,975.00

Hospital Charge Code	270663627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

TISSUE EXPANDER MATRIX 500CC

Facility

$7,975.00

Hospital Charge Code	270663627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Tissue Expander Matrix 600cc

Facility

$7,975.00

Hospital Charge Code	270663628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Tissue Expander Matrix 600cc

Facility

$7,975.00

Hospital Charge Code	270663628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

TISSUE EXPANDERS 800cc W/TABS

Facility

$6,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270673926
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

TISSUE EXPANDERS 800cc W/TABS

Facility

$6,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270673926
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

TISSUE EXPANDERS 900cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270673927
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

TISSUE EXPANDERS 900cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270673927
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

TISSUE EXTRACTOR BRUSH BENT

Facility

$1,250.00

Hospital Charge Code	270674906
Hospital Revenue Code	272
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

TISSUE EXTRACTOR BRUSH BENT

Facility

$1,250.00

Hospital Charge Code	270674906
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

TISSUE,FACIAL 5X8 IN BOX

Facility

$1.22

Hospital Charge Code	270652969
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.18

TISSUE,FACIAL 5X8 IN BOX

Facility

$1.22

Hospital Charge Code	270652969
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna Commercial	$0.37
Rate for Payer: Aetna Medicare Advantage	$0.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.31
Rate for Payer: Cigna Commercial	$0.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.16
Rate for Payer: Oxford Commercial	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.18
Rate for Payer: UnitedHealthcare Commercial	$0.61

TISSUE FEM CNDYLLE HEMI LF LAT

Facility

$59,265.00

Hospital Charge Code	270684017
Hospital Revenue Code	278
Min. Negotiated Rate	$8,889.75
Max. Negotiated Rate	$14,342.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75

TISSUE FEM CNDYLLE HEMI LF LAT

Facility

$59,265.00

Hospital Charge Code	270684017
Hospital Revenue Code	278
Min. Negotiated Rate	$8,889.75
Max. Negotiated Rate	$29,632.50
Rate for Payer: Aetna Commercial	$17,779.50
Rate for Payer: Aetna Medicare Advantage	$17,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,112.58
Rate for Payer: Cigna Commercial	$29,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75

TISSUE GRAFTS OTHER

Facility

$26,848.40

Service Code	HCPCS 15769
Hospital Charge Code	1600000620
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

TISSUE GRAFTS OTHER

Facility

$26,848.40

Service Code	HCPCS 15769
Hospital Charge Code	1600000620
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,439.01
Rate for Payer: Aetna Commercial	$8,054.52
Rate for Payer: Aetna Medicare Advantage	$8,054.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,846.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,846.34
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	$6,846.34
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,490.29
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

TISSUE HUMAN DBM PLUS 10CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270663413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$2,812.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

TISSUE HUMAN DBM PLUS 10CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270663413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

TISSUE HUMAN DBM PLUS 5CC

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270663414
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TISSUE HUMAN DBM PLUS 5CC

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270663414
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TISSUE MATRIX 1x2CM THICK

Facility

$1,015.00

Hospital Charge Code	270675237
Hospital Revenue Code	636
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$507.50
Rate for Payer: Aetna Commercial	$304.50
Rate for Payer: Aetna Medicare Advantage	$304.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.82
Rate for Payer: Cigna Commercial	$507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.63
Rate for Payer: Qualcare PPO/HMO/WC	$152.25

TISSUE MATRIX 1x2CM THICK

Facility

$1,015.00

Hospital Charge Code	270675237
Hospital Revenue Code	636
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$245.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.63
Rate for Payer: Qualcare PPO/HMO/WC	$152.25

TISSUE MATRIX 5 X 7

Facility

$7,500.00

Hospital Charge Code	270666123
Hospital Revenue Code	636
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

Know your out-of-pocket cost for care.

All Charges