Heights University Hospital

All Charges

Charge

Type

Setting

Price

RESTRAINT TORSO BELT MED

Facility

$100.00

Hospital Charge Code	270301077
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

RESTRAINT TORSO BELT MED

Facility

$100.00

Hospital Charge Code	270301077
Hospital Revenue Code	270
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

RESTRAINT TORSO BELT SM

Facility

$100.00

Hospital Charge Code	270301076
Hospital Revenue Code	270
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

RESTRAINT TORSO BELT SM

Facility

$100.00

Hospital Charge Code	270301076
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

RESTRAINT TORSO BELT XLG

Facility

$110.45

Hospital Charge Code	270301079
Hospital Revenue Code	270
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

RESTRAINT TORSO BELT XLG

Facility

$110.45

Hospital Charge Code	270301079
Hospital Revenue Code	270
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$55.23
Rate for Payer: Aetna Commercial	$33.13
Rate for Payer: Aetna Medicare Advantage	$33.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.16
Rate for Payer: Cigna Commercial	$55.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.36
Rate for Payer: Oxford Commercial	$55.23
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$55.23

RESTRATA MESHED 5CMX5CM

Facility

$13,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704823
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
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) NJ Health	$2,750.00
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	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

RESTRATA MESHED 5CMX5CM

Facility

$13,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704823
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

RESTRATA MESHED 7.5CMX 7.5CM

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704824
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

RESTRATA MESHED 7.5CMX 7.5CM

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704824
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$5,625.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

RESTRATA MINIMATRIX 1000MG

Facility

$23,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270704827
Hospital Revenue Code	278
Min. Negotiated Rate	$3,517.50
Max. Negotiated Rate	$11,725.00
Rate for Payer: Aetna Commercial	$7,035.00
Rate for Payer: Aetna Medicare Advantage	$7,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,979.75
Rate for Payer: Cigna Commercial	$11,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,674.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.50

RESTRATA MINIMATRIX 1000MG

Facility

$23,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270704827
Hospital Revenue Code	278
Min. Negotiated Rate	$3,517.50
Max. Negotiated Rate	$5,674.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,674.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.50

RESTRATA MINIMATRIX 500MG

Facility

$12,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704826
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.50
Max. Negotiated Rate	$6,225.00
Rate for Payer: Aetna Commercial	$3,735.00
Rate for Payer: Aetna Medicare Advantage	$3,735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,174.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,174.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,174.75
Rate for Payer: Cigna Commercial	$6,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.50

RESTRATA MINIMATRIX 500MG

Facility

$12,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704826
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.50
Max. Negotiated Rate	$3,012.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.50

RESTRICTOR BUCK CEMENT PLUG***

Facility

$50.00

Hospital Charge Code	1606359
Hospital Revenue Code	279
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

RESTRICTOR BUCK CEMENT PLUG***

Facility

$50.00

Hospital Charge Code	1606359
Hospital Revenue Code	279
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$25.00

RESTRICTOR BUCKS CEMENT

Facility

$784.00

Hospital Charge Code	270600346
Hospital Revenue Code	274
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$392.00
Rate for Payer: Aetna Commercial	$235.20
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.73
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

RESTRICTOR BUCKS CEMENT

Facility

$784.00

Hospital Charge Code	270600346
Hospital Revenue Code	274
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$189.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.73
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

RESTRICTOR BUCKS CEMENT PLUG

Facility

$668.00

Hospital Charge Code	270600347
Hospital Revenue Code	272
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$100.20
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

RESTRICTOR BUCKS CEMENT PLUG

Facility

$668.00

Hospital Charge Code	270600347
Hospital Revenue Code	272
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$200.40
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.84
Rate for Payer: Oxford Commercial	$334.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Commercial	$334.00

RESTRICTOR CEMENT 8-13MM

Facility

$475.00

Hospital Charge Code	270668557
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

RESTRICTOR CEMENT 8-13MM

Facility

$475.00

Hospital Charge Code	270668557
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

RESTRICTOR CEM SZ2 10.75MM FEM

Facility

$1,255.00

Service Code	HCPCS C1776
Hospital Charge Code	270697345
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$627.50
Rate for Payer: Aetna Commercial	$376.50
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

RESTRICTOR CEM SZ2 10.75MM FEM

Facility

$1,255.00

Service Code	HCPCS C1776
Hospital Charge Code	270697345
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$303.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

RESTRICTOR FEM CEMENT 25MM

Facility

$668.00

Hospital Charge Code	270601213
Hospital Revenue Code	272
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$200.40
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.84
Rate for Payer: Oxford Commercial	$334.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Commercial	$334.00

Know your out-of-pocket cost for care.

All Charges