Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$215.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: Qualcare PPO/HMO/WC	$133.68

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	$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 60MM BENT

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	270702663
Hospital Revenue Code	278
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$42.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

ROD 60MM BENT

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	270702663
Hospital Revenue Code	278
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.35
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

ROD 65MM

Facility

$2,625.00

Service Code	HCPCS C1716
Hospital Charge Code	270701774
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

ROD 65MM

Facility

$3,280.00

Hospital Charge Code	270667338
Hospital Revenue Code	278
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: Qualcare PPO/HMO/WC	$492.00

ROD 65MM

Facility

$2,625.00

Service Code	HCPCS C1716
Hospital Charge Code	270701774
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$1,197.08
Rate for Payer: Aetna Commercial	$787.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

ROD 65MM

Facility

$3,280.00

Hospital Charge Code	270667338
Hospital Revenue Code	278
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$1,640.00
Rate for Payer: Aetna Commercial	$984.00
Rate for Payer: Aetna Medicare Advantage	$984.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.40
Rate for Payer: Cigna Commercial	$1,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: Qualcare PPO/HMO/WC	$492.00

ROD 6.5x40mm 9690040

Facility

$1,542.65

Hospital Charge Code	270630337
Hospital Revenue Code	278
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$771.33
Rate for Payer: Aetna Commercial	$462.80
Rate for Payer: Aetna Medicare Advantage	$462.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.38
Rate for Payer: Cigna Commercial	$771.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: Qualcare PPO/HMO/WC	$231.40

ROD 6.5x40mm 9690040

Facility

$1,542.65

Hospital Charge Code	270630337
Hospital Revenue Code	278
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$373.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: Qualcare PPO/HMO/WC	$231.40

ROD 6.5x50mm 9690050

Facility

$1,542.65

Hospital Charge Code	270630636
Hospital Revenue Code	278
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$373.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: Qualcare PPO/HMO/WC	$231.40

ROD 6.5x50mm 9690050

Facility

$1,542.65

Hospital Charge Code	270630636
Hospital Revenue Code	278
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$771.33
Rate for Payer: Aetna Commercial	$462.80
Rate for Payer: Aetna Medicare Advantage	$462.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.38
Rate for Payer: Cigna Commercial	$771.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.32
Rate for Payer: Qualcare PPO/HMO/WC	$231.40

ROD 6X35MM REF #016.3035

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705831
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

ROD 6X35MM REF #016.3035

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705831
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

ROD 6X40MM REF#016.3040

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705832
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

ROD 6X40MM REF#016.3040

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705832
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

ROD 70MM

Facility

$1,375.00

Hospital Charge Code	270703138
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$412.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

ROD 70MM

Facility

$1,375.00

Hospital Charge Code	270703138
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

ROD 70MM

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270701775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ROD 70MM

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270701775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ROD 75MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692284
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

ROD 75MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692284
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

ROD 80 MM

Facility

$2,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693061
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$892.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

ROD 80 MM

Facility

$2,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693061
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$719.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

ROD 80MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704748
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

Know your out-of-pocket cost for care.

All Charges