Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

TISSUE MATRIX 6x12CM

Facility

$13,535.00

Service Code	HCPCS Q4116
Hospital Charge Code	270685337
Hospital Revenue Code	278
Min. Negotiated Rate	$2,030.25
Max. Negotiated Rate	$3,275.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,707.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,275.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,030.25

TISSUE MATRIX 6x12CM

Facility

$13,535.00

Service Code	HCPCS Q4116
Hospital Charge Code	270685337
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,060.50
Rate for Payer: Aetna Commercial	$4,060.50
Rate for Payer: Aetna Medicare Advantage	$4,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,451.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,451.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,707.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,451.43
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,275.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,030.25

TISSUE MATRIX LIQUID LARGE

Facility

$27,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270674908
Hospital Revenue Code	278
Min. Negotiated Rate	$4,080.00
Max. Negotiated Rate	$6,582.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,582.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,080.00

TISSUE MATRIX LIQUID LARGE

Facility

$27,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270674908
Hospital Revenue Code	278
Min. Negotiated Rate	$4,080.00
Max. Negotiated Rate	$13,600.00
Rate for Payer: Aetna Commercial	$8,160.00
Rate for Payer: Aetna Medicare Advantage	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,936.00
Rate for Payer: Cigna Commercial	$13,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,582.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,080.00

TISSUEMEND 6CMX 10 CM

Facility

$15,784.25

Service Code	HCPCS Q4100
Hospital Charge Code	270686061
Hospital Revenue Code	636
Min. Negotiated Rate	$2,367.64
Max. Negotiated Rate	$7,892.12
Rate for Payer: Aetna Commercial	$4,735.27
Rate for Payer: Aetna Medicare Advantage	$4,735.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,024.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,024.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,024.98
Rate for Payer: Cigna Commercial	$7,892.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,819.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,367.64

TISSUEMEND 6CMX 10 CM

Facility

$15,784.25

Service Code	HCPCS Q4100
Hospital Charge Code	270686061
Hospital Revenue Code	636
Min. Negotiated Rate	$2,367.64
Max. Negotiated Rate	$3,819.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,819.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,367.64

TISSUE PKP FULL THICKNESS

Facility

$17,250.00

Hospital Charge Code	270688742
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

TISSUE PKP FULL THICKNESS

Facility

$17,250.00

Hospital Charge Code	270688742
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$5,175.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

TISSUE REMOVAL KIT

Facility

$4,225.00

Hospital Charge Code	270662181
Hospital Revenue Code	272
Min. Negotiated Rate	$549.25
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,267.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$549.25
Rate for Payer: Oxford Commercial	$2,112.50
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Commercial	$2,112.50

TISSUE REMOVAL KIT

Facility

$4,225.00

Hospital Charge Code	270662181
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$633.75
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

TISSUE REMOVAL KIT TX2

Facility

$4,225.00

Hospital Charge Code	270677971
Hospital Revenue Code	272
Min. Negotiated Rate	$549.25
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,267.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$549.25
Rate for Payer: Oxford Commercial	$2,112.50
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Commercial	$2,112.50

TISSUE REMOVAL KIT TX2

Facility

$4,225.00

Hospital Charge Code	270677971
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$633.75
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

TISSUE RIB SEGMENT 100650

Facility

$2,815.25

Hospital Charge Code	270610653
Hospital Revenue Code	272
Min. Negotiated Rate	$422.29
Max. Negotiated Rate	$422.29
Rate for Payer: Qualcare PPO/HMO/WC	$422.29

TISSUE RIB SEGMENT 100650

Facility

$2,815.25

Hospital Charge Code	270610653
Hospital Revenue Code	272
Min. Negotiated Rate	$365.98
Max. Negotiated Rate	$1,407.62
Rate for Payer: Cigna Commercial	$1,407.62
Rate for Payer: Aetna Commercial	$844.58
Rate for Payer: Aetna Medicare Advantage	$844.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$717.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$717.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$717.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$365.98
Rate for Payer: Oxford Commercial	$1,407.62
Rate for Payer: Qualcare PPO/HMO/WC	$422.29
Rate for Payer: UnitedHealthcare Commercial	$1,407.62

TISSUE RIB SEGMENT SPLT 500655

Facility

$1,310.45

Hospital Charge Code	270613507
Hospital Revenue Code	272
Min. Negotiated Rate	$170.36
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$393.13
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.36
Rate for Payer: Oxford Commercial	$655.23
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$655.23

TISSUE RIB SEGMENT SPLT 500655

Facility

$1,310.45

Hospital Charge Code	270613507
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

TISSUES FACIAL 5x8-1/4

Facility

$0.91

Hospital Charge Code	270649124
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.14

TISSUES FACIAL 5x8-1/4

Facility

$0.91

Hospital Charge Code	270649124
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna Commercial	$0.27
Rate for Payer: Aetna Medicare Advantage	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.23
Rate for Payer: Cigna Commercial	$0.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.12
Rate for Payer: Oxford Commercial	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.14
Rate for Payer: UnitedHealthcare Commercial	$0.46

TISSUE SPLITTER

Facility

$4,234.40

Service Code	HCPCS C1889
Hospital Charge Code	270705738
Hospital Revenue Code	278
Min. Negotiated Rate	$635.16
Max. Negotiated Rate	$1,024.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.72
Rate for Payer: Qualcare PPO/HMO/WC	$635.16

TISSUE SPLITTER

Facility

$4,234.40

Service Code	HCPCS C1889
Hospital Charge Code	270705738
Hospital Revenue Code	278
Min. Negotiated Rate	$635.16
Max. Negotiated Rate	$2,117.20
Rate for Payer: Aetna Commercial	$1,270.32
Rate for Payer: Aetna Medicare Advantage	$1,270.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.77
Rate for Payer: Cigna Commercial	$2,117.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.72
Rate for Payer: Qualcare PPO/HMO/WC	$635.16

TISSUE SPLITTER BLADE SPIN

Facility

$5,231.25

Service Code	HCPCS A4649
Hospital Charge Code	270697433
Hospital Revenue Code	272
Min. Negotiated Rate	$784.69
Max. Negotiated Rate	$784.69
Rate for Payer: Qualcare PPO/HMO/WC	$784.69

TISSUE SPLITTER BLADE SPIN

Facility

$5,231.25

Service Code	HCPCS A4649
Hospital Charge Code	270697433
Hospital Revenue Code	272
Min. Negotiated Rate	$680.06
Max. Negotiated Rate	$2,615.62
Rate for Payer: Aetna Medicare Advantage	$1,569.38
Rate for Payer: Aetna Commercial	$1,569.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,333.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,333.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,333.97
Rate for Payer: Cigna Commercial	$2,615.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.06
Rate for Payer: Oxford Commercial	$2,615.62
Rate for Payer: Qualcare PPO/HMO/WC	$784.69
Rate for Payer: UnitedHealthcare Commercial	$2,615.62

TISSUE TIBIALIS ANT 26C 921198

Facility

$7,936.00

Hospital Charge Code	270633564
Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.40
Max. Negotiated Rate	$1,190.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,190.40

TISSUE TIBIALIS ANT 26C 921198

Facility

$7,936.00

Hospital Charge Code	270633564
Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.68
Max. Negotiated Rate	$3,968.00
Rate for Payer: Aetna Commercial	$2,380.80
Rate for Payer: Aetna Medicare Advantage	$2,380.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,023.68
Rate for Payer: Cigna Commercial	$3,968.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,031.68
Rate for Payer: Oxford Commercial	$3,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,190.40
Rate for Payer: UnitedHealthcare Commercial	$3,968.00

Know your out-of-pocket cost for care.

All Charges