Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROD LORDOTIC RELINE 5.5 X30 MM

Facility

$4,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270682868
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,498.50
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

ROD LORDOTIC RELINE 5.5 X30 MM

Facility

$4,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270682868
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

ROD LORDOTIC RELINE MAS 5.5X35

Facility

$4,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270682869
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,498.50
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

ROD LORDOTIC RELINE MAS 5.5X35

Facility

$4,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270682869
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

ROD LORDOTIC TI 5.5X120MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694187
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 LORDOTIC TI 5.5X120MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694187
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 LORDOTIC TI 5.5X35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694827
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 LORDOTIC TI 5.5X35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694827
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 LORDOTIC TI 5.5X45MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694646
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 LORDOTIC TI 5.5X45MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694646
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 LORDOTIC TI 5.5X50MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694647
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 LORDOTIC TI 5.5X50MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694647
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 LORDOTIC TI 5.5X65MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692446
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 LORDOTIC TI 5.5X65MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695318
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 LORDOTIC TI 5.5X65MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695318
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 LORDOTIC TI 5.5X65MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692446
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 LORDOTIC TI 5.5X70MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695319
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 LORDOTIC TI 5.5X70MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695319
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 LORDOTIC TI 5.5X75MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692449
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 LORDOTIC TI 5.5X75MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692449
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 LORDOTIC TI CL 5.5X80MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695891
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 LORDOTIC TI CL 5.5X80MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695891
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 LORDOTIC TI STR 3.5X240MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694824
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 LORDOTIC TI STR 3.5X240MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694824
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 LORDOTR PREBENT 55MM

Facility

$4,580.00

Hospital Charge Code	270657316
Hospital Revenue Code	278
Min. Negotiated Rate	$687.00
Max. Negotiated Rate	$2,290.00
Rate for Payer: Aetna Commercial	$1,374.00
Rate for Payer: Aetna Medicare Advantage	$1,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,167.90
Rate for Payer: Cigna Commercial	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: Qualcare PPO/HMO/WC	$687.00

Know your out-of-pocket cost for care.

All Charges