Heights University Hospital

All Charges

Charge

Type

Setting

Price

INCISOR 3.5MM

Facility

$616.00

Hospital Charge Code	270601295
Hospital Revenue Code	272
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$92.40

INCISOR 4.5MM

Facility

$454.55

Hospital Charge Code	270676717
Hospital Revenue Code	272
Min. Negotiated Rate	$59.09
Max. Negotiated Rate	$227.28
Rate for Payer: Aetna Commercial	$136.37
Rate for Payer: Aetna Medicare Advantage	$136.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.91
Rate for Payer: Cigna Commercial	$227.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.09
Rate for Payer: Oxford Commercial	$227.28
Rate for Payer: Qualcare PPO/HMO/WC	$68.18
Rate for Payer: UnitedHealthcare Commercial	$227.28

INCISOR 4.5MM

Facility

$454.55

Hospital Charge Code	270676717
Hospital Revenue Code	272
Min. Negotiated Rate	$68.18
Max. Negotiated Rate	$68.18
Rate for Payer: Qualcare PPO/HMO/WC	$68.18

INCISOR CVD CONCAVE 4.5MM

Facility

$780.00

Hospital Charge Code	270601296
Hospital Revenue Code	272
Min. Negotiated Rate	$101.40
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Commercial	$390.00

INCISOR CVD CONCAVE 4.5MM

Facility

$780.00

Hospital Charge Code	270601296
Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

INCISOR STRAIGHT 4.5MM

Facility

$616.00

Hospital Charge Code	270601294
Hospital Revenue Code	272
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$92.40

INCISOR STRAIGHT 4.5MM

Facility

$616.00

Hospital Charge Code	270601294
Hospital Revenue Code	272
Min. Negotiated Rate	$80.08
Max. Negotiated Rate	$308.00
Rate for Payer: Aetna Commercial	$184.80
Rate for Payer: Aetna Medicare Advantage	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.08
Rate for Payer: Cigna Commercial	$308.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.08
Rate for Payer: Oxford Commercial	$308.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.40
Rate for Payer: UnitedHealthcare Commercial	$308.00

INCORE

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270688020
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$414.00
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270688020
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 3.5MM X 28MM TI SCREW

Facility

$1,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270692231
Hospital Revenue Code	278
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$820.00
Rate for Payer: Aetna Commercial	$492.00
Rate for Payer: Aetna Medicare Advantage	$492.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$418.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$418.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$328.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$418.20
Rate for Payer: Cigna Commercial	$820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.88
Rate for Payer: Qualcare PPO/HMO/WC	$246.00

INCORE 3.5MM X 28MM TI SCREW

Facility

$1,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270692231
Hospital Revenue Code	278
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$396.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$328.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.88
Rate for Payer: Qualcare PPO/HMO/WC	$246.00

INCORE 3.5MM X 36MM TI SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687659
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$414.00
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 3.5MM X 36MM TI SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687659
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 3.5MM X 44MM TI SCREW

Facility

$1,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270692232
Hospital Revenue Code	278
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$820.00
Rate for Payer: Aetna Commercial	$492.00
Rate for Payer: Aetna Medicare Advantage	$492.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$418.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$418.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$328.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$418.20
Rate for Payer: Cigna Commercial	$820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.88
Rate for Payer: Qualcare PPO/HMO/WC	$246.00

INCORE 3.5MM X 44MM TI SCREW

Facility

$1,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270692232
Hospital Revenue Code	278
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$396.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$328.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.88
Rate for Payer: Qualcare PPO/HMO/WC	$246.00

INCORE 3.5MM X 48MM TI SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687658
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$414.00
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 3.5MM X 48MM TI SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687658
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 3.5 X 56MM SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687706
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$414.00
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 3.5 X 56MM SCREW

Facility

$1,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270687706
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

INCORE 5.9MMX 28MM

Facility

$17,440.00

Service Code	HCPCS C1713
Hospital Charge Code	270687705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,616.00
Max. Negotiated Rate	$4,220.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,220.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,616.00

INCORE 5.9MMX 28MM

Facility

$17,440.00

Service Code	HCPCS C1713
Hospital Charge Code	270687705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,616.00
Max. Negotiated Rate	$8,720.00
Rate for Payer: Aetna Commercial	$5,232.00
Rate for Payer: Aetna Medicare Advantage	$5,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,447.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,447.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,447.20
Rate for Payer: Cigna Commercial	$8,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,220.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,616.00

INCORE 5.9MM X 28MM TI SCREW

Facility

$22,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270692230
Hospital Revenue Code	278
Min. Negotiated Rate	$3,427.50
Max. Negotiated Rate	$11,425.00
Rate for Payer: Aetna Commercial	$6,855.00
Rate for Payer: Aetna Medicare Advantage	$6,855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,826.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,826.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,826.75
Rate for Payer: Cigna Commercial	$11,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,529.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.50

INCORE 5.9MM X 28MM TI SCREW

Facility

$22,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270692230
Hospital Revenue Code	278
Min. Negotiated Rate	$3,427.50
Max. Negotiated Rate	$5,529.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,529.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.50

INCORE TORQ LIMIT DVR

Facility

$1,410.00

Hospital Charge Code	270692229
Hospital Revenue Code	272
Min. Negotiated Rate	$183.30
Max. Negotiated Rate	$705.00
Rate for Payer: Aetna Commercial	$423.00
Rate for Payer: Aetna Medicare Advantage	$423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.55
Rate for Payer: Cigna Commercial	$705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.30
Rate for Payer: Oxford Commercial	$705.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.50
Rate for Payer: UnitedHealthcare Commercial	$705.00

INCORE TORQ LIMIT DVR

Facility

$1,410.00

Hospital Charge Code	270692229
Hospital Revenue Code	272
Min. Negotiated Rate	$211.50
Max. Negotiated Rate	$211.50
Rate for Payer: Qualcare PPO/HMO/WC	$211.50

Know your out-of-pocket cost for care.

All Charges