Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROD END CURV 5.5 40 535-5040

Facility

$1,604.75

Hospital Charge Code	270628752
Hospital Revenue Code	278
Min. Negotiated Rate	$240.71
Max. Negotiated Rate	$388.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.35
Rate for Payer: Qualcare PPO/HMO/WC	$240.71

ROD EXPEDIUM 120MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669374
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

ROD EXPEDIUM 120MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669374
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

ROD EXPEDIUM 300MM

Facility

$2,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270683735
Hospital Revenue Code	278
Min. Negotiated Rate	$438.75
Max. Negotiated Rate	$707.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$707.85
Rate for Payer: Qualcare PPO/HMO/WC	$438.75

ROD EXPEDIUM 300MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270673344
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

ROD EXPEDIUM 300MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270673344
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

ROD EXPEDIUM 300MM

Facility

$2,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270683735
Hospital Revenue Code	278
Min. Negotiated Rate	$438.75
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna Commercial	$877.50
Rate for Payer: Aetna Medicare Advantage	$877.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$745.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$745.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$745.88
Rate for Payer: Cigna Commercial	$1,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$707.85
Rate for Payer: Qualcare PPO/HMO/WC	$438.75

ROD EXTENDED TAB 30MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270693811
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 EXTENDED TAB 30MM

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270693811
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 EXTENDED TAB 80MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694701
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

ROD EXTENDED TAB 80MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694701
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$168.00
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

ROD EXTENDED TAB 85MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694702
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

ROD EXTENDED TAB 85MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270694702
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$168.00
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

ROD EXTENSION SHUKLA 4IN DISP

Facility

$2,750.00

Hospital Charge Code	270696261
Hospital Revenue Code	272
Min. Negotiated Rate	$357.50
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) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$357.50
Rate for Payer: Oxford Commercial	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$1,375.00

ROD EXTENSION SHUKLA 4IN DISP

Facility

$2,750.00

Hospital Charge Code	270696261
Hospital Revenue Code	272
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD EXTND TAB 50MM OVRWTCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692587
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 EXTND TAB 50MM OVRWTCH MIS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692587
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 FIXED 60 MM PALISADE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692238
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD FIXED 60 MM PALISADE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692238
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD HMD CONNECT 5/100 50495510

Facility

$292.85

Hospital Charge Code	270619343
Hospital Revenue Code	278
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$146.43
Rate for Payer: Aetna Commercial	$87.86
Rate for Payer: Aetna Medicare Advantage	$87.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.68
Rate for Payer: Cigna Commercial	$146.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.87
Rate for Payer: Qualcare PPO/HMO/WC	$43.93

ROD HMD CONNECT 5/100 50495510

Facility

$292.85

Hospital Charge Code	270619343
Hospital Revenue Code	278
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$70.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.87
Rate for Payer: Qualcare PPO/HMO/WC	$43.93

ROD HMD CONNECT 5/150 50495515

Facility

$307.25

Hospital Charge Code	270619344
Hospital Revenue Code	278
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$74.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

ROD HMD CONNECT 5/150 50495515

Facility

$307.25

Hospital Charge Code	270619344
Hospital Revenue Code	278
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$92.17
Rate for Payer: Aetna Medicare Advantage	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.35
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

ROD HMD CONNECT 5/200 50495520

Facility

$323.25

Hospital Charge Code	270619345
Hospital Revenue Code	278
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$78.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.23
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

ROD HMD CONNECT 5/200 50495520

Facility

$323.25

Hospital Charge Code	270619345
Hospital Revenue Code	278
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$161.62
Rate for Payer: Aetna Commercial	$96.97
Rate for Payer: Aetna Medicare Advantage	$96.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.43
Rate for Payer: Cigna Commercial	$161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.23
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

Know your out-of-pocket cost for care.

All Charges