Heights University Hospital

All Charges

Charge

Type

Setting

Price

3-D VOLUMN RECONSTRUCTIO

Facility

$928.00

Service Code	HCPCS 76377
Hospital Charge Code	94061155
Hospital Revenue Code	402
Min. Negotiated Rate	$88.73
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$278.40
Rate for Payer: Aetna Medicare Advantage	$278.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.64
Rate for Payer: Cigna Commercial	$88.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.64
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.20
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

3-D VOLUMN RECONSTRUCTIO

Facility

$928.00

Service Code	HCPCS 76377
Hospital Charge Code	94061155
Hospital Revenue Code	402
Min. Negotiated Rate	$139.20
Max. Negotiated Rate	$139.20
Rate for Payer: Qualcare PPO/HMO/WC	$139.20

3 HOLE VDR PLATE

Facility

$9,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270706028
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

3 HOLE VDR PLATE

Facility

$9,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270706028
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$2,722.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

3 LONG 180 RINGS

Facility

$5,775.00

Hospital Charge Code	270656620
Hospital Revenue Code	272
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$866.25
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

3 LONG 180 RINGS

Facility

$5,775.00

Hospital Charge Code	270656620
Hospital Revenue Code	272
Min. Negotiated Rate	$750.75
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$1,732.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.75
Rate for Payer: Oxford Commercial	$2,887.50
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Commercial	$2,887.50

3 LVL PLATE 45MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704424
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

3 LVL PLATE 45MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704424
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

3MM DRILLBIT FOR 4.5MM SCREW

Facility

$785.00

Hospital Charge Code	270703979
Hospital Revenue Code	279
Min. Negotiated Rate	$102.05
Max. Negotiated Rate	$392.50
Rate for Payer: Aetna Commercial	$235.50
Rate for Payer: Aetna Medicare Advantage	$235.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.18
Rate for Payer: Cigna Commercial	$392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.05
Rate for Payer: Oxford Commercial	$392.50
Rate for Payer: Qualcare PPO/HMO/WC	$117.75
Rate for Payer: UnitedHealthcare Commercial	$392.50

3MM DRILLBIT FOR 4.5MM SCREW

Facility

$785.00

Hospital Charge Code	270703979
Hospital Revenue Code	279
Min. Negotiated Rate	$117.75
Max. Negotiated Rate	$117.75
Rate for Payer: Qualcare PPO/HMO/WC	$117.75

3 PEG PATELLA/7.2MM THICKNESS

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668734
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

3 PEG PATELLA/7.2MM THICKNESS

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668734
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

3 SHELF METRO DEEP LEDGE UTILI

Facility

$1,325.25

Hospital Charge Code	270662655
Hospital Revenue Code	270
Min. Negotiated Rate	$198.79
Max. Negotiated Rate	$198.79
Rate for Payer: Qualcare PPO/HMO/WC	$198.79

3 SHELF METRO DEEP LEDGE UTILI

Facility

$1,325.25

Hospital Charge Code	270662655
Hospital Revenue Code	270
Min. Negotiated Rate	$172.28
Max. Negotiated Rate	$662.62
Rate for Payer: Aetna Commercial	$397.57
Rate for Payer: Aetna Medicare Advantage	$397.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.94
Rate for Payer: Cigna Commercial	$662.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.28
Rate for Payer: Oxford Commercial	$662.62
Rate for Payer: Qualcare PPO/HMO/WC	$198.79
Rate for Payer: UnitedHealthcare Commercial	$662.62

3X12MM HYBRID SCREW

Facility

$643.75

Service Code	HCPCS C1713
Hospital Charge Code	270705522
Hospital Revenue Code	278
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$155.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.79
Rate for Payer: Qualcare PPO/HMO/WC	$96.56

3X12MM HYBRID SCREW

Facility

$643.75

Service Code	HCPCS C1713
Hospital Charge Code	270705522
Hospital Revenue Code	278
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$321.88
Rate for Payer: Aetna Commercial	$193.12
Rate for Payer: Aetna Medicare Advantage	$193.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.16
Rate for Payer: Cigna Commercial	$321.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.79
Rate for Payer: Qualcare PPO/HMO/WC	$96.56

4.0/2.5MM SELF-DR SCHANZ SCRW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270680657
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$220.56
Rate for Payer: Aetna Medicare Advantage	$220.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.48
Rate for Payer: Cigna Commercial	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0/2.5MM SELF-DR SCHANZ SCRW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270680657
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$177.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0/3.0MM SCHANZ SCREW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270619756
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$177.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0/3.0MM SCHANZ SCREW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270619756
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$220.56
Rate for Payer: Aetna Medicare Advantage	$220.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.48
Rate for Payer: Cigna Commercial	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0 CAN BEV HL COM SCR 38MM L

Facility

$4,075.00

Hospital Charge Code	270703231
Hospital Revenue Code	278
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$2,037.50
Rate for Payer: Aetna Commercial	$1,222.50
Rate for Payer: Aetna Medicare Advantage	$1,222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.12
Rate for Payer: Cigna Commercial	$2,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

4.0 CAN BEV HL COM SCR 38MM L

Facility

$4,075.00

Hospital Charge Code	270703231
Hospital Revenue Code	278
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$986.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

4.0 CANN CANC LAG SCR 44MM

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270682616
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

4.0 CANN CANC LAG SCR 44MM

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270682616
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$398.75
Rate for Payer: Aetna Commercial	$239.25
Rate for Payer: Aetna Medicare Advantage	$239.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.36
Rate for Payer: Cigna Commercial	$398.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

4.0MM/4.0MM CLAMP

Facility

$1,435.40

Hospital Charge Code	270601807
Hospital Revenue Code	272
Min. Negotiated Rate	$186.60
Max. Negotiated Rate	$717.70
Rate for Payer: Aetna Commercial	$430.62
Rate for Payer: Aetna Medicare Advantage	$430.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.03
Rate for Payer: Cigna Commercial	$717.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.60
Rate for Payer: Oxford Commercial	$717.70
Rate for Payer: Qualcare PPO/HMO/WC	$215.31
Rate for Payer: UnitedHealthcare Commercial	$717.70

Know your out-of-pocket cost for care.

All Charges