Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT ROI-C LORDOSE 12 X 15.

Facility

$11,666.65

Service Code	HCPCS C1713
Hospital Charge Code	270684352
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$2,823.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,823.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.00

IMPLANT ROI-C LORDOSE 12 X 15.

Facility

$11,666.65

Service Code	HCPCS C1713
Hospital Charge Code	270684352
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$5,833.32
Rate for Payer: Aetna Commercial	$3,499.99
Rate for Payer: Aetna Medicare Advantage	$3,499.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,975.00
Rate for Payer: Cigna Commercial	$5,833.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,823.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.00

IMPLANT SCLERA QUARTER

Facility

$1,500.00

Hospital Charge Code	270683332
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

IMPLANT SCLERA QUARTER

Facility

$1,500.00

Hospital Charge Code	270683332
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

IMPLANT SGL TOE FLEX 426-0050

Facility

$4,482.45

Hospital Charge Code	270619528
Hospital Revenue Code	278
Min. Negotiated Rate	$672.37
Max. Negotiated Rate	$1,084.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$896.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,084.75
Rate for Payer: Qualcare PPO/HMO/WC	$672.37

IMPLANT SGL TOE FLEX 426-0050

Facility

$4,482.45

Hospital Charge Code	270619528
Hospital Revenue Code	278
Min. Negotiated Rate	$672.37
Max. Negotiated Rate	$2,241.22
Rate for Payer: Aetna Commercial	$1,344.73
Rate for Payer: Aetna Medicare Advantage	$1,344.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,143.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,143.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$896.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,143.02
Rate for Payer: Cigna Commercial	$2,241.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,084.75
Rate for Payer: Qualcare PPO/HMO/WC	$672.37

IMPLANT SGL TOE LONG 80-100-01

Facility

$1,915.25

Hospital Charge Code	270615425
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$463.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE LONG 80-100-01

Facility

$1,915.25

Hospital Charge Code	270615425
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$957.62
Rate for Payer: Aetna Commercial	$574.58
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$957.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE MED 70-100-02

Facility

$1,915.25

Hospital Charge Code	270615424
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$463.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE MED 70-100-02

Facility

$1,915.25

Hospital Charge Code	270615424
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$957.62
Rate for Payer: Aetna Commercial	$574.58
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$957.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE SMAL 70-100-01

Facility

$1,915.25

Hospital Charge Code	270615423
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$463.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE SMAL 70-100-01

Facility

$1,915.25

Hospital Charge Code	270615423
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$957.62
Rate for Payer: Aetna Commercial	$574.58
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$957.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SHAW FLEXBLE 90-100-01

Facility

$818.45

Hospital Charge Code	270631286
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$409.23
Rate for Payer: Aetna Commercial	$245.53
Rate for Payer: Aetna Medicare Advantage	$245.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.70
Rate for Payer: Cigna Commercial	$409.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW FLEXBLE 90-100-01

Facility

$818.45

Hospital Charge Code	270631286
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$198.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW REGULAR 90-100-02

Facility

$818.45

Hospital Charge Code	270631287
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$409.23
Rate for Payer: Aetna Commercial	$245.53
Rate for Payer: Aetna Medicare Advantage	$245.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.70
Rate for Payer: Cigna Commercial	$409.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW REGULAR 90-100-02

Facility

$818.45

Hospital Charge Code	270631287
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$198.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW STIFF 9010003

Facility

$818.45

Hospital Charge Code	270631288
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$409.23
Rate for Payer: Aetna Commercial	$245.53
Rate for Payer: Aetna Medicare Advantage	$245.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.70
Rate for Payer: Cigna Commercial	$409.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW STIFF 9010003

Facility

$818.45

Hospital Charge Code	270631288
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$198.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHORTEN MET SLOT 2.7

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270701869
Hospital Revenue Code	278
Min. Negotiated Rate	$447.75
Max. Negotiated Rate	$1,492.50
Rate for Payer: Aetna Commercial	$895.50
Rate for Payer: Aetna Medicare Advantage	$895.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$597.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.17
Rate for Payer: Cigna Commercial	$1,492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.37
Rate for Payer: Qualcare PPO/HMO/WC	$447.75

IMPLANT SHORTEN MET SLOT 2.7

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270701869
Hospital Revenue Code	278
Min. Negotiated Rate	$447.75
Max. Negotiated Rate	$722.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$597.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.37
Rate for Payer: Qualcare PPO/HMO/WC	$447.75

IMPLANT SINUS TARSI SZ 6

Facility

$7,900.05

Hospital Charge Code	270647216
Hospital Revenue Code	278
Min. Negotiated Rate	$1,185.01
Max. Negotiated Rate	$3,950.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.01
Rate for Payer: Aetna Commercial	$2,370.01
Rate for Payer: Aetna Medicare Advantage	$2,370.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,014.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,014.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,580.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,014.51
Rate for Payer: Cigna Commercial	$3,950.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,911.81

IMPLANT SINUS TARSI SZ 6

Facility

$7,900.05

Hospital Charge Code	270647216
Hospital Revenue Code	278
Min. Negotiated Rate	$1,185.01
Max. Negotiated Rate	$1,911.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,580.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,911.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.01

IMPLANT SMALL 10 DEG ANGLED

Facility

$5,390.00

Hospital Charge Code	270675709
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$2,695.00
Rate for Payer: Aetna Commercial	$1,617.00
Rate for Payer: Aetna Medicare Advantage	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,374.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,374.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,374.45
Rate for Payer: Cigna Commercial	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.38
Rate for Payer: Qualcare PPO/HMO/WC	$808.50

IMPLANT SMALL 10 DEG ANGLED

Facility

$5,390.00

Hospital Charge Code	270675709
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,304.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,078.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.38
Rate for Payer: Qualcare PPO/HMO/WC	$808.50

IMPLANT SMART TOE ST 0-16

Facility

$1,750.00

Hospital Charge Code	270639822
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

Know your out-of-pocket cost for care.

All Charges