Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROD PALISADE FIXED 30MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692239
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 PALISADE FIXED 30MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692239
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 PANTA2 COMPRESSION 5MM

Facility

$10,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.75
Max. Negotiated Rate	$5,062.50
Rate for Payer: Aetna Commercial	$3,037.50
Rate for Payer: Aetna Medicare Advantage	$3,037.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,581.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,581.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,581.88
Rate for Payer: Cigna Commercial	$5,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,450.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,518.75

ROD PANTA2 COMPRESSION 5MM

Facility

$10,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.75
Max. Negotiated Rate	$2,450.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,450.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,518.75

ROD PERC CCM 4.75X65MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699279
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 PERC CCM 4.75X65MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699279
Hospital Revenue Code	278
Min. Negotiated Rate	$480.75
Max. Negotiated Rate	$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: Cigna Commercial	$1,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: Qualcare PPO/HMO/WC	$480.75

ROD PERC TI 5.5X100MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699076
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 PERC TI 5.5X100MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699076
Hospital Revenue Code	278
Min. Negotiated Rate	$480.75
Max. Negotiated Rate	$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: Cigna Commercial	$1,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: Qualcare PPO/HMO/WC	$480.75

ROD POCT STRAIGHT TI 3.5X350MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695760
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 POCT STRAIGHT TI 3.5X350MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695760
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 PRE-BENT 3.5MM 80-215 COCR

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270697897
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

ROD PRE-BENT 3.5MM 80-215 COCR

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270697897
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

ROD PRE-BENT 50MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706024
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE-BENT 50MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706024
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE-BENT 70MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705828
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE-BENT 70MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705828
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PREBENT TBOLT TI 5.5X45MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696795
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD PREBENT TBOLT TI 5.5X45MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696795
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD PREBENT TBOLT TI 5.5X70MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695408
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD PREBENT TBOLT TI 5.5X70MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695408
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

ROD PREBENT W HEX AND TAP 55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692302
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PREBENT W HEX AND TAP 55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692302
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PREBENT W HEX AND TAP 70MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692301
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PREBENT W HEX AND TAP 70MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692301
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE BNT CDH 5.5x40 8690040

Facility

$1,542.65

Hospital Charge Code	270630623
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

Know your out-of-pocket cost for care.

All Charges