Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROD CARBON FIBER 8.0mm X 280mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644918
Hospital Revenue Code	278
Min. Negotiated Rate	$105.67
Max. Negotiated Rate	$352.25
Rate for Payer: Aetna Commercial	$211.35
Rate for Payer: Aetna Medicare Advantage	$211.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.65
Rate for Payer: Cigna Commercial	$352.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: Qualcare PPO/HMO/WC	$105.67

ROD CARBON FIBER 9.5x350mm

Facility

$990.00

Hospital Charge Code	270672337
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$297.00
Rate for Payer: Aetna Medicare Advantage	$297.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.45
Rate for Payer: Cigna Commercial	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: Qualcare PPO/HMO/WC	$148.50

ROD CARBON FIBER 9.5x350mm

Facility

$990.00

Hospital Charge Code	270672337
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: Qualcare PPO/HMO/WC	$148.50

ROD CD SOLERA TI PERC 5.5X90MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699431
Hospital Revenue Code	278
Min. Negotiated Rate	$480.75
Max. Negotiated Rate	$775.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: Qualcare PPO/HMO/WC	$480.75

ROD CD SOLERA TI PERC 5.5X90MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699431
Hospital Revenue Code	278
Min. Negotiated Rate	$480.75
Max. Negotiated Rate	$1,602.50
Rate for Payer: Cigna Commercial	$1,602.50
Rate for Payer: Aetna Commercial	$961.50
Rate for Payer: Aetna Medicare Advantage	$961.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$817.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$817.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$817.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: Qualcare PPO/HMO/WC	$480.75

ROD & CLAMP 8/8mm MRI 49211010

Facility

$3,665.00

Hospital Charge Code	270643402
Hospital Revenue Code	272
Min. Negotiated Rate	$476.45
Max. Negotiated Rate	$1,832.50
Rate for Payer: Aetna Commercial	$1,099.50
Rate for Payer: Aetna Medicare Advantage	$1,099.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$934.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$934.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$934.58
Rate for Payer: Cigna Commercial	$1,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.45
Rate for Payer: Oxford Commercial	$1,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$549.75
Rate for Payer: UnitedHealthcare Commercial	$1,832.50

ROD & CLAMP 8/8mm MRI 49211010

Facility

$3,665.00

Hospital Charge Code	270643402
Hospital Revenue Code	272
Min. Negotiated Rate	$549.75
Max. Negotiated Rate	$549.75
Rate for Payer: Qualcare PPO/HMO/WC	$549.75

ROD CLAMP RING 393436

Facility

$4,128.25

Service Code	HCPCS C1713
Hospital Charge Code	270632994
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$2,064.12
Rate for Payer: Aetna Commercial	$1,238.47
Rate for Payer: Aetna Medicare Advantage	$1,238.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.70
Rate for Payer: Cigna Commercial	$2,064.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: Qualcare PPO/HMO/WC	$619.24

ROD CLAMP RING 393436

Facility

$4,128.25

Service Code	HCPCS C1713
Hospital Charge Code	270632994
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$999.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: Qualcare PPO/HMO/WC	$619.24

ROD CL PERC TI 5.5X45MMROD CL

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695964
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 CL PERC TI 5.5X45MMROD CL

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695964
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 CONN ADJUSTING LG****

Facility

$485.00

Hospital Charge Code	1601905
Hospital Revenue Code	274
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

ROD CONN ADJUSTING LG****

Facility

$485.00

Hospital Charge Code	1601905
Hospital Revenue Code	274
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$242.50
Rate for Payer: Aetna Commercial	$145.50
Rate for Payer: Aetna Medicare Advantage	$145.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Commercial	$242.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

ROD CONNECT CAR 8x250 50288250

Facility

$1,955.00

Hospital Charge Code	270643442
Hospital Revenue Code	278
Min. Negotiated Rate	$293.25
Max. Negotiated Rate	$473.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.11
Rate for Payer: Qualcare PPO/HMO/WC	$293.25

ROD CONNECT CAR 8x250 50288250

Facility

$1,955.00

Hospital Charge Code	270643442
Hospital Revenue Code	278
Min. Negotiated Rate	$293.25
Max. Negotiated Rate	$977.50
Rate for Payer: Aetna Commercial	$586.50
Rate for Payer: Aetna Medicare Advantage	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$498.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$498.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$498.52
Rate for Payer: Cigna Commercial	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.11
Rate for Payer: Qualcare PPO/HMO/WC	$293.25

ROD CONNECTING 11X200MM

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270669477
Hospital Revenue Code	278
Min. Negotiated Rate	$379.50
Max. Negotiated Rate	$612.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.26
Rate for Payer: Qualcare PPO/HMO/WC	$379.50

ROD CONNECTING 11X200MM

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270669477
Hospital Revenue Code	278
Min. Negotiated Rate	$379.50
Max. Negotiated Rate	$1,265.00
Rate for Payer: Aetna Commercial	$759.00
Rate for Payer: Aetna Medicare Advantage	$759.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$645.15
Rate for Payer: Cigna Commercial	$1,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.26
Rate for Payer: Qualcare PPO/HMO/WC	$379.50

ROD CONNECTING 11X350MM

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Charge Code	270669476
Hospital Revenue Code	278
Min. Negotiated Rate	$389.25
Max. Negotiated Rate	$627.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.99
Rate for Payer: Qualcare PPO/HMO/WC	$389.25

ROD CONNECTING 11X350MM

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Charge Code	270669476
Hospital Revenue Code	278
Min. Negotiated Rate	$389.25
Max. Negotiated Rate	$1,297.50
Rate for Payer: Aetna Commercial	$778.50
Rate for Payer: Aetna Medicare Advantage	$778.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$661.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$661.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$661.73
Rate for Payer: Cigna Commercial	$1,297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.99
Rate for Payer: Qualcare PPO/HMO/WC	$389.25

ROD CONNECTING 8x400mm MRI

Facility

$2,240.00

Hospital Charge Code	270648002
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$672.00
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

ROD CONNECTING 8x400mm MRI

Facility

$2,240.00

Hospital Charge Code	270648002
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$542.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

ROD CONNECTING 8x450mm MRI

Facility

$2,240.00

Hospital Charge Code	270648001
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$542.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

ROD CONNECTING 8x450mm MRI

Facility

$2,240.00

Hospital Charge Code	270648001
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$672.00
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

ROD CONNECTING LG FA100003

Facility

$4,811.25

Hospital Charge Code	270621621
Hospital Revenue Code	278
Min. Negotiated Rate	$721.69
Max. Negotiated Rate	$1,164.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$962.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,164.32
Rate for Payer: Qualcare PPO/HMO/WC	$721.69

ROD CONNECTING LG FA100003

Facility

$4,811.25

Hospital Charge Code	270621621
Hospital Revenue Code	278
Min. Negotiated Rate	$721.69
Max. Negotiated Rate	$2,405.62
Rate for Payer: Aetna Commercial	$1,443.38
Rate for Payer: Aetna Medicare Advantage	$1,443.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,226.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,226.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$962.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,226.87
Rate for Payer: Cigna Commercial	$2,405.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,164.32
Rate for Payer: Qualcare PPO/HMO/WC	$721.69

Know your out-of-pocket cost for care.

All Charges