Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROD REFORM LORDOT TI 3.5X80MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696962
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 REFORM POCT 3.5X120MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694815
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 REFORM POCT 3.5X120MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694815
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 REFORM TI PED 5.5X60MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696107
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 REFORM TI PED 5.5X60MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696107
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 RELINE-O TI LORDO 5.5X35MM

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	270695242
Hospital Revenue Code	278
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$958.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: Qualcare PPO/HMO/WC	$594.00

ROD RELINE-O TI LORDO 5.5X35MM

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	270695242
Hospital Revenue Code	278
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$1,980.00
Rate for Payer: Aetna Commercial	$1,188.00
Rate for Payer: Aetna Medicare Advantage	$1,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,009.80
Rate for Payer: Cigna Commercial	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: Qualcare PPO/HMO/WC	$594.00

ROD RELINE TI 5.5X60MM LORDOT

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693812
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 RELINE TI 5.5X60MM LORDOT

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693812
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 RING/THD CONNECTING M6 NUT

Facility

$161.65

Service Code	HCPCS C1713
Hospital Charge Code	270674288
Hospital Revenue Code	272
Min. Negotiated Rate	$24.25
Max. Negotiated Rate	$24.25
Rate for Payer: Qualcare PPO/HMO/WC	$24.25

ROD RING/THD CONNECTING M6 NUT

Facility

$161.65

Service Code	HCPCS C1713
Hospital Charge Code	270674288
Hospital Revenue Code	272
Min. Negotiated Rate	$21.01
Max. Negotiated Rate	$80.83
Rate for Payer: Aetna Commercial	$48.49
Rate for Payer: Aetna Medicare Advantage	$48.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.22
Rate for Payer: Cigna Commercial	$80.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.01
Rate for Payer: Oxford Commercial	$80.83
Rate for Payer: Qualcare PPO/HMO/WC	$24.25
Rate for Payer: UnitedHealthcare Commercial	$80.83

RODS 25MM

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270690487
Hospital Revenue Code	278
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$454.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.96
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

RODS 25MM

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270690487
Hospital Revenue Code	278
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Commercial	$564.00
Rate for Payer: Aetna Medicare Advantage	$564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.40
Rate for Payer: Cigna Commercial	$940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.96
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

ROD SDK 5.5MM 20IN 855-011

Facility

$2,100.00

Hospital Charge Code	270613599
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$630.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

ROD SDK 5.5MM 20IN 855-011

Facility

$2,100.00

Hospital Charge Code	270613599
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

ROD SDK 5.5MM 855-012

Facility

$2,054.45

Hospital Charge Code	270616994
Hospital Revenue Code	278
Min. Negotiated Rate	$308.17
Max. Negotiated Rate	$497.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.18
Rate for Payer: Qualcare PPO/HMO/WC	$308.17

ROD SDK 5.5MM 855-012

Facility

$2,054.45

Hospital Charge Code	270616994
Hospital Revenue Code	278
Min. Negotiated Rate	$308.17
Max. Negotiated Rate	$1,027.22
Rate for Payer: Aetna Commercial	$616.34
Rate for Payer: Aetna Medicare Advantage	$616.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$523.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$523.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$523.88
Rate for Payer: Cigna Commercial	$1,027.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.18
Rate for Payer: Qualcare PPO/HMO/WC	$308.17

ROD SEMI-CIRC CURVED MRI

Facility

$2,015.00

Hospital Charge Code	270648000
Hospital Revenue Code	272
Min. Negotiated Rate	$261.95
Max. Negotiated Rate	$1,007.50
Rate for Payer: Aetna Commercial	$604.50
Rate for Payer: Aetna Medicare Advantage	$604.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$513.83
Rate for Payer: Cigna Commercial	$1,007.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.95
Rate for Payer: Oxford Commercial	$1,007.50
Rate for Payer: Qualcare PPO/HMO/WC	$302.25
Rate for Payer: UnitedHealthcare Commercial	$1,007.50

ROD SEMI-CIRC CURVED MRI

Facility

$2,015.00

Hospital Charge Code	270648000
Hospital Revenue Code	272
Min. Negotiated Rate	$302.25
Max. Negotiated Rate	$302.25
Rate for Payer: Qualcare PPO/HMO/WC	$302.25

ROD SEMI CIRCULAR 11X220MM

Facility

$3,300.00

Hospital Charge Code	270669874
Hospital Revenue Code	278
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$798.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

ROD SEMI CIRCULAR 11X220MM

Facility

$3,300.00

Hospital Charge Code	270669874
Hospital Revenue Code	278
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$1,650.00
Rate for Payer: Aetna Commercial	$990.00
Rate for Payer: Aetna Medicare Advantage	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.50
Rate for Payer: Cigna Commercial	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

ROD SEMI CURVED

Facility

$2,165.00

Hospital Charge Code	270662208
Hospital Revenue Code	278
Min. Negotiated Rate	$324.75
Max. Negotiated Rate	$1,082.50
Rate for Payer: Aetna Commercial	$649.50
Rate for Payer: Aetna Medicare Advantage	$649.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.08
Rate for Payer: Cigna Commercial	$1,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$523.93
Rate for Payer: Qualcare PPO/HMO/WC	$324.75

ROD SEMI CURVED

Facility

$2,165.00

Hospital Charge Code	270662208
Hospital Revenue Code	278
Min. Negotiated Rate	$324.75
Max. Negotiated Rate	$523.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$523.93
Rate for Payer: Qualcare PPO/HMO/WC	$324.75

RODS JOINTED 3.5X12MM 72MM

Facility

$9,303.00

Service Code	HCPCS C1713
Hospital Charge Code	270694401
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.45
Max. Negotiated Rate	$4,651.50
Rate for Payer: Aetna Commercial	$2,790.90
Rate for Payer: Aetna Medicare Advantage	$2,790.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,372.26
Rate for Payer: Cigna Commercial	$4,651.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,251.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

RODS JOINTED 3.5X12MM 72MM

Facility

$9,303.00

Service Code	HCPCS C1713
Hospital Charge Code	270694401
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.45
Max. Negotiated Rate	$2,251.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,860.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,251.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

Know your out-of-pocket cost for care.

All Charges