Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTERBODY DEV 17.5X14X7MMH

Facility

$4,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705473
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INTERBODY DEV 17.5X14X7MMH

Facility

$4,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705473
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INTERBODY DEVICE 15X12X9 7D

Facility

$27,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699422
Hospital Revenue Code	278
Min. Negotiated Rate	$4,050.00
Max. Negotiated Rate	$13,500.00
Rate for Payer: Aetna Commercial	$8,100.00
Rate for Payer: Aetna Medicare Advantage	$8,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,885.00
Rate for Payer: Cigna Commercial	$13,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,534.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,050.00

INTERBODY DEVICE 15X12X9 7D

Facility

$27,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699422
Hospital Revenue Code	278
Min. Negotiated Rate	$4,050.00
Max. Negotiated Rate	$6,534.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,534.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,050.00

INTERBODY DEVICE 9X28X8MM 5DEG

Facility

$34,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694852
Hospital Revenue Code	278
Min. Negotiated Rate	$5,137.50
Max. Negotiated Rate	$8,288.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,288.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,137.50

INTERBODY DEVICE 9X28X8MM 5DEG

Facility

$34,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694852
Hospital Revenue Code	278
Min. Negotiated Rate	$5,137.50
Max. Negotiated Rate	$17,125.00
Rate for Payer: Aetna Commercial	$10,275.00
Rate for Payer: Aetna Medicare Advantage	$10,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,733.75
Rate for Payer: Cigna Commercial	$17,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,288.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,137.50

INTERBODY DEVICE CERV TITANIUM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

INTERBODY DEVICE CERV TITANIUM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

INTERBODY FUS DEVICE 7 DEG H8M

Facility

$20,000.00

Hospital Charge Code	270702964
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUS DEVICE 7 DEG H8M

Facility

$20,000.00

Hospital Charge Code	270702964
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUS DEVICE 7DEG H8MM

Facility

$20,000.00

Hospital Charge Code	270702962
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUS DEVICE 7DEG H8MM

Facility

$20,000.00

Hospital Charge Code	270702962
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUSION DEV 15X12X5MM

Facility

$15,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270705028
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY FUSION DEV 15X12X5MM

Facility

$15,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270705028
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$4,650.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY FUSION DEV 7DEG LORD

Facility

$20,000.00

Hospital Charge Code	270702367
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUSION DEV 7DEG LORD

Facility

$20,000.00

Hospital Charge Code	270702367
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUSION DEVICE

Facility

$20,000.00

Hospital Charge Code	270702963
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUSION DEVICE

Facility

$20,000.00

Hospital Charge Code	270702963
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$4,650.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704520
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704520
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$4,650.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY PROSTH 18X15X6MM 7D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694452
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$7,275.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

INTERBODY PROSTH 18X15X6MM 7D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694452
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

INTERBODY STANDALONE 12X17X7MM

Facility

$32,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270669220
Hospital Revenue Code	278
Min. Negotiated Rate	$4,893.75
Max. Negotiated Rate	$16,312.50
Rate for Payer: Aetna Commercial	$9,787.50
Rate for Payer: Aetna Medicare Advantage	$9,787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,319.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,319.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,319.38
Rate for Payer: Cigna Commercial	$16,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,895.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,893.75

Know your out-of-pocket cost for care.

All Charges