Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROD 4.75MM COB CHR CAPPED 40MM

Facility

$6,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270697070
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$3,425.00
Rate for Payer: Aetna Commercial	$2,055.00
Rate for Payer: Aetna Medicare Advantage	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.75
Rate for Payer: Cigna Commercial	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

ROD 50 MM

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270691519
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

ROD 50 MM

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270691519
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,087.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

ROD 50MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270705518
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

ROD 50MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270705518
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

ROD 50MM

Facility

$875.00

Hospital Charge Code	270702972
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

ROD 50MM

Facility

$875.00

Hospital Charge Code	270702972
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

ROD 55MM OVERWATCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692592
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$210.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

ROD 55MM OVERWATCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692592
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

ROD 5.5mm x 50mm 8690050

Facility

$1,636.85

Hospital Charge Code	270632421
Hospital Revenue Code	278
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.12
Rate for Payer: Qualcare PPO/HMO/WC	$245.53

ROD 5.5mm x 50mm 8690050

Facility

$1,636.85

Hospital Charge Code	270632421
Hospital Revenue Code	278
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$818.42
Rate for Payer: Aetna Commercial	$491.06
Rate for Payer: Aetna Medicare Advantage	$491.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.40
Rate for Payer: Cigna Commercial	$818.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.12
Rate for Payer: Qualcare PPO/HMO/WC	$245.53

ROD 5.5 TI CP4 NS CRV 80MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698928
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$378.00
Rate for Payer: Aetna Medicare Advantage	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.30
Rate for Payer: Cigna Commercial	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 TI CP4 NS CRV 80MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698928
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$304.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 TI CP4 NS CRV 90MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698927
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$378.00
Rate for Payer: Aetna Medicare Advantage	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.30
Rate for Payer: Cigna Commercial	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 TI CP4 NS CRV 90MM

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Charge Code	270698927
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$304.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.92
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

ROD 5.5 X110MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694078
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$825.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD 5.5 X110MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694078
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD 5.5x55MM CURVED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680799
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 5.5x55MM CURVED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680799
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Aetna Commercial	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 55x80MM LORDOSED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680081
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 55x80MM LORDOSED

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680081
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$487.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

ROD 60MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688861
Hospital Revenue Code	278
Min. Negotiated Rate	$133.68
Max. Negotiated Rate	$445.60
Rate for Payer: Aetna Commercial	$267.36
Rate for Payer: Aetna Medicare Advantage	$267.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.26
Rate for Payer: Cigna Commercial	$445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: Qualcare PPO/HMO/WC	$133.68

ROD 60MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681180
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

ROD 60MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697038
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$825.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD 60MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681180
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

Know your out-of-pocket cost for care.

All Charges