Heights University Hospital

All Charges

Charge

Type

Setting

Price

MATT TC BARIATRIC PLUS W/FOAM

Facility

$440.00

Hospital Charge Code	270654641
Hospital Revenue Code	271
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

MATT TC BARIATRIC PLUS W/FOAM

Facility

$440.00

Hospital Charge Code	270654641
Hospital Revenue Code	271
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$132.00
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.20
Rate for Payer: Oxford Commercial	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Commercial	$220.00

MATULANE/50MG/CAP

Facility

$6.00

Hospital Charge Code	60633356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

MATULANE/50MG/CAP

Facility

$6.00

Hospital Charge Code	60633356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MAT ULTRA-THIN FLEXIBLE

Facility

$290.86

Hospital Charge Code	270635762
Hospital Revenue Code	271
Min. Negotiated Rate	$37.81
Max. Negotiated Rate	$145.43
Rate for Payer: Aetna Commercial	$87.26
Rate for Payer: Aetna Medicare Advantage	$87.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.17
Rate for Payer: Cigna Commercial	$145.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.81
Rate for Payer: Oxford Commercial	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$43.63
Rate for Payer: UnitedHealthcare Commercial	$145.43

MAT ULTRA-THIN FLEXIBLE

Facility

$290.86

Hospital Charge Code	270635762
Hospital Revenue Code	271
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$43.63
Rate for Payer: Qualcare PPO/HMO/WC	$43.63

MAXBRD#5 MO-6-NDL

Facility

$600.00

Hospital Charge Code	270688617
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MAXBRD#5 MO-6-NDL

Facility

$600.00

Hospital Charge Code	270688617
Hospital Revenue Code	272
Min. Negotiated Rate	$78.00
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) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$300.00

MAXBREADED MO 6 BK BL SUTURE

Facility

$650.00

Hospital Charge Code	270691310
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

MAXBREADED MO 6 BK BL SUTURE

Facility

$650.00

Hospital Charge Code	270691310
Hospital Revenue Code	272
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$325.00

MAXCESS KIT 4

Facility

$17,310.00

Hospital Charge Code	270659707
Hospital Revenue Code	272
Min. Negotiated Rate	$2,250.30
Max. Negotiated Rate	$8,655.00
Rate for Payer: Aetna Commercial	$5,193.00
Rate for Payer: Aetna Medicare Advantage	$5,193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,414.05
Rate for Payer: Cigna Commercial	$8,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,250.30
Rate for Payer: Oxford Commercial	$8,655.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50
Rate for Payer: UnitedHealthcare Commercial	$8,655.00

MAXCESS KIT 4

Facility

$17,310.00

Hospital Charge Code	270659707
Hospital Revenue Code	272
Min. Negotiated Rate	$2,596.50
Max. Negotiated Rate	$2,596.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50

MAXCESS MAS PLIF USAGE

Facility

$10,965.00

Hospital Charge Code	270663763
Hospital Revenue Code	270
Min. Negotiated Rate	$1,644.75
Max. Negotiated Rate	$1,644.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.75

MAXCESS MAS PLIF USAGE

Facility

$10,965.00

Hospital Charge Code	270663763
Hospital Revenue Code	270
Min. Negotiated Rate	$1,425.45
Max. Negotiated Rate	$5,482.50
Rate for Payer: Aetna Commercial	$3,289.50
Rate for Payer: Aetna Medicare Advantage	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,796.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,796.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,796.07
Rate for Payer: Cigna Commercial	$5,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.45
Rate for Payer: Oxford Commercial	$5,482.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.75
Rate for Payer: UnitedHealthcare Commercial	$5,482.50

MAXCESS MAS TLIF 2 KIT ACCESS

Facility

$18,375.00

Hospital Charge Code	270693335
Hospital Revenue Code	272
Min. Negotiated Rate	$2,388.75
Max. Negotiated Rate	$9,187.50
Rate for Payer: Aetna Commercial	$5,512.50
Rate for Payer: Aetna Medicare Advantage	$5,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,685.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,685.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,685.62
Rate for Payer: Cigna Commercial	$9,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,388.75
Rate for Payer: Oxford Commercial	$9,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,756.25
Rate for Payer: UnitedHealthcare Commercial	$9,187.50

MAXCESS MAS TLIF 2 KIT ACCESS

Facility

$18,375.00

Hospital Charge Code	270693335
Hospital Revenue Code	272
Min. Negotiated Rate	$2,756.25
Max. Negotiated Rate	$2,756.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,756.25

MAXCESSMASTLIF2KITLATRETRACT

Facility

$13,750.00

Hospital Charge Code	270697195
Hospital Revenue Code	272
Min. Negotiated Rate	$1,787.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$4,125.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,787.50
Rate for Payer: Oxford Commercial	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Commercial	$6,875.00

MAXCESSMASTLIF2KITLATRETRACT

Facility

$13,750.00

Hospital Charge Code	270697195
Hospital Revenue Code	272
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

MAXEPINE 1GM IN D5W

Facility

$61.00

Hospital Charge Code	60635524
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

MAXEPINE 1GM IN D5W

Facility

$61.00

Hospital Charge Code	60635524
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

MAXEPINE 1GM IN NS

Facility

$61.00

Hospital Charge Code	60635525
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

MAXEPINE 1GM IN NS

Facility

$61.00

Hospital Charge Code	60635525
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

MAXFORCE PLATE LEFT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270705523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.14
Max. Negotiated Rate	$5,137.12
Rate for Payer: Aetna Commercial	$3,082.28
Rate for Payer: Aetna Medicare Advantage	$3,082.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,619.93
Rate for Payer: Cigna Commercial	$5,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14

MAXFORCE PLATE LEFT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270705523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.14
Max. Negotiated Rate	$2,486.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14

MAXFORCE PLATE PETITE RIGHT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270693500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.14
Max. Negotiated Rate	$5,137.12
Rate for Payer: Aetna Commercial	$3,082.28
Rate for Payer: Aetna Medicare Advantage	$3,082.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,619.93
Rate for Payer: Cigna Commercial	$5,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14

Know your out-of-pocket cost for care.

All Charges