Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSERT SPHERE FLEX L 12MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683384
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 13MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681285
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 13MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681285
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 17 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683460
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 17 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683460
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 17MM S5

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681424
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 17MM S5

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681424
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX R 17MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681147
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX R 17MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681147
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX R 20 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683392
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX R 20 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683392
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX RIGHT 14 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681359
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX RIGHT 14 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681359
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE INSTR SET I2R-T2

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684547
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

INSERT SPHERE INSTR SET I2R-T2

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684547
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

INSERT SPINE FIX DEVICE 3-6

Facility

$25,282.63

Service Code	HCPCS 22842
Hospital Charge Code	16000469
Hospital Revenue Code	360
Min. Negotiated Rate	$3,792.39
Max. Negotiated Rate	$3,792.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39

INSERT SPINE FIX DEVICE 3-6

Facility

$25,282.63

Service Code	HCPCS 22842
Hospital Charge Code	16000469
Hospital Revenue Code	360
Min. Negotiated Rate	$736.84
Max. Negotiated Rate	$7,584.79
Rate for Payer: Aetna Commercial	$7,584.79
Rate for Payer: Aetna Medicare Advantage	$7,584.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,447.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,447.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,447.07
Rate for Payer: Cigna Commercial	$736.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.74
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INSERT SPINE FXTN DVC4-7 SEG

Facility

$25,282.63

Service Code	HCPCS 22846
Hospital Charge Code	162003
Hospital Revenue Code	360
Min. Negotiated Rate	$729.61
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$7,584.79
Rate for Payer: Aetna Medicare Advantage	$7,584.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,447.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,447.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,447.07
Rate for Payer: Cigna Commercial	$729.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

INSERT SPINE FXTN DVC4-7 SEG

Facility

$25,282.63

Service Code	HCPCS 22846
Hospital Charge Code	162003
Hospital Revenue Code	360
Min. Negotiated Rate	$3,792.39
Max. Negotiated Rate	$3,792.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39

INSERT SUBQ CARD RHYTHM MON

Facility

$43,408.82

Service Code	HCPCS 33285
Hospital Charge Code	411033285
Hospital Revenue Code	361
Min. Negotiated Rate	$6,511.32
Max. Negotiated Rate	$6,511.32
Rate for Payer: Qualcare PPO/HMO/WC	$6,511.32

INSERT SUBQ CARD RHYTHM MON

Facility

$43,408.82

Service Code	HCPCS 33285
Hospital Charge Code	703033285
Hospital Revenue Code	481
Min. Negotiated Rate	$6,511.32
Max. Negotiated Rate	$6,511.32
Rate for Payer: Qualcare PPO/HMO/WC	$6,511.32

INSERT SUBQ CARD RHYTHM MON

Facility

$43,408.82

Service Code	HCPCS 33285
Hospital Charge Code	403433285
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$19,706.96
Rate for Payer: Aetna Commercial	$13,022.65
Rate for Payer: Aetna Medicare Advantage	$13,022.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,069.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,069.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,069.25
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,643.15
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,511.32
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

INSERT SUBQ CARD RHYTHM MON

Facility

$43,408.82

Service Code	HCPCS 33285
Hospital Charge Code	366833285
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$19,706.96
Rate for Payer: Aetna Commercial	$13,022.65
Rate for Payer: Aetna Medicare Advantage	$13,022.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,069.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,069.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,069.25
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,643.15
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,511.32
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

INSERT SUBQ CARD RHYTHM MON

Facility

$43,408.82

Service Code	HCPCS 33285
Hospital Charge Code	366833285
Hospital Revenue Code	361
Min. Negotiated Rate	$6,511.32
Max. Negotiated Rate	$6,511.32
Rate for Payer: Qualcare PPO/HMO/WC	$6,511.32

INSERT SUBQ CARD RHYTHM MON

Facility

$43,408.82

Service Code	HCPCS 33285
Hospital Charge Code	403433285
Hospital Revenue Code	361
Min. Negotiated Rate	$6,511.32
Max. Negotiated Rate	$6,511.32
Rate for Payer: Qualcare PPO/HMO/WC	$6,511.32

Know your out-of-pocket cost for care.

All Charges