Heights University Hospital

All Charges

Charge

Type

Setting

Price

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$26.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$103.00

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83092015
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83080030
Hospital Revenue Code	771
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$26.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$103.00

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83092015
Hospital Revenue Code	771
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$26.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$103.00

PED THREADED LOCKING 2.3x26MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664406
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$156.00
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PED THREADED LOCKING 2.3x26MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664406
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEDVAXHIB VACCINE

Facility

$705.91

Service Code	NDC 6489700
Hospital Charge Code	606350930
Hospital Revenue Code	250
Min. Negotiated Rate	$105.89
Max. Negotiated Rate	$105.89
Rate for Payer: Qualcare PPO/HMO/WC	$105.89

PEDVAXHIB VACCINE

Facility

$705.91

Service Code	NDC 6489700
Hospital Charge Code	606350930
Hospital Revenue Code	250
Min. Negotiated Rate	$91.77
Max. Negotiated Rate	$352.95
Rate for Payer: Aetna Commercial	$211.77
Rate for Payer: Aetna Medicare Advantage	$211.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.01
Rate for Payer: Cigna Commercial	$352.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.77
Rate for Payer: Oxford Commercial	$352.95
Rate for Payer: Qualcare PPO/HMO/WC	$105.89
Rate for Payer: UnitedHealthcare Commercial	$352.95

PEEK 12x12x7

Facility

$11,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270669949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$5,570.00
Rate for Payer: Aetna Commercial	$3,342.00
Rate for Payer: Aetna Medicare Advantage	$3,342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.70
Rate for Payer: Cigna Commercial	$5,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK 12x12x7

Facility

$11,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270669949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$2,695.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK CAGE ROIC LORDOTIC COATED

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270691790
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

PEEK CAGE ROIC LORDOTIC COATED

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270691790
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

PEEK CORKSCREW 4.5 MM

Facility

$2,040.00

Hospital Charge Code	270657692
Hospital Revenue Code	278
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Aetna Commercial	$612.00
Rate for Payer: Aetna Medicare Advantage	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.20
Rate for Payer: Cigna Commercial	$1,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.68
Rate for Payer: Qualcare PPO/HMO/WC	$306.00

PEEK CORKSCREW 4.5 MM

Facility

$2,040.00

Hospital Charge Code	270657692
Hospital Revenue Code	278
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$493.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.68
Rate for Payer: Qualcare PPO/HMO/WC	$306.00

PEEK IMPLANT CSI XLG WIFS

Facility

$87,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697104
Hospital Revenue Code	278
Min. Negotiated Rate	$13,125.00
Max. Negotiated Rate	$21,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,125.00

PEEK IMPLANT CSI XLG WIFS

Facility

$87,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697104
Hospital Revenue Code	278
Min. Negotiated Rate	$13,125.00
Max. Negotiated Rate	$43,750.00
Rate for Payer: Aetna Commercial	$26,250.00
Rate for Payer: Aetna Medicare Advantage	$26,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,312.50
Rate for Payer: Cigna Commercial	$43,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,125.00

PEEK INTERBODY 12MMX12MMX7M

Facility

$13,500.00

Hospital Charge Code	270661262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK INTERBODY 12MMX12MMX7M

Facility

$13,500.00

Hospital Charge Code	270661262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK LORDOTIC 12x12x7MM

Facility

$11,140.00

Hospital Charge Code	270659694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$2,695.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK LORDOTIC 12x12x7MM

Facility

$11,140.00

Hospital Charge Code	270659694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$5,570.00
Rate for Payer: Aetna Commercial	$3,342.00
Rate for Payer: Aetna Medicare Advantage	$3,342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.70
Rate for Payer: Cigna Commercial	$5,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK LORDOTIC 12 X 12 X 8

Facility

$13,500.00

Hospital Charge Code	270659693
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK LORDOTIC 12 X 12 X 8

Facility

$13,500.00

Hospital Charge Code	270659693
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK OPTIMA LT+1 TANTALUM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686591
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$6,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

PEEK OPTIMA LT+1 TANTALUM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686591
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$14,000.00
Rate for Payer: Aetna Commercial	$8,400.00
Rate for Payer: Aetna Medicare Advantage	$8,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,140.00
Rate for Payer: Cigna Commercial	$14,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

Know your out-of-pocket cost for care.

All Charges