Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW MIS PEDICLE 6.5X45MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS PEDICLE 6.5X45MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS PEDICLE 6.5X50MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS PEDICLE 6.5X50MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS POL EXT TAB 7.5X35MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270697645
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,260.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

SCREW MIS POL EXT TAB 7.5X35MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270697645
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

SCREW MIS POLY EX TAB 5.5X45MM

Facility

$5,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693175
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

SCREW MIS POLY EX TAB 5.5X45MM

Facility

$5,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693175
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

SCREW MIS REDUCTION

Facility

$5,000.00

Hospital Charge Code	270703023
Hospital Revenue Code	270
Min. Negotiated Rate	$650.00
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) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

SCREW MIS REDUCTION

Facility

$5,000.00

Hospital Charge Code	270703023
Hospital Revenue Code	270
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SCREW MNTR F/A 3.5x10MM

Facility

$6,600.00

Hospital Charge Code	270663774
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x10MM

Facility

$6,600.00

Hospital Charge Code	270663774
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x12MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270663775
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x12MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270663775
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x14MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270669974
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20

SCREW MNTR F/A 3.5x14MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270669974
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x16MM

Facility

$6,600.00

Hospital Charge Code	270664087
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x16MM

Facility

$6,600.00

Hospital Charge Code	270664087
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR M/L 3.5x14MM

Facility

$6,600.00

Hospital Charge Code	270663786
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR M/L 3.5x14MM

Facility

$6,600.00

Hospital Charge Code	270663786
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR M/L 3.5x16MM

Facility

$6,600.00

Hospital Charge Code	270663783
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR M/L 3.5x16MM

Facility

$6,600.00

Hospital Charge Code	270663783
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR M/L 3.5x18MM

Facility

$6,600.00

Hospital Charge Code	270663787
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR M/L 3.5x18MM

Facility

$6,600.00

Hospital Charge Code	270663787
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR OC 4.5x8MM

Facility

$1,505.00

Service Code	HCPCS C1713
Hospital Charge Code	270677389
Hospital Revenue Code	278
Min. Negotiated Rate	$225.75
Max. Negotiated Rate	$752.50
Rate for Payer: Aetna Commercial	$451.50
Rate for Payer: Aetna Medicare Advantage	$451.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$301.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.77
Rate for Payer: Cigna Commercial	$752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.21
Rate for Payer: Qualcare PPO/HMO/WC	$225.75

Know your out-of-pocket cost for care.

All Charges