Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW POCT POLYAX 3.5X26MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695758
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLY 3.5x 14 MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681777
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

SCREW POLY 3.5x 14 MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681777
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

SCREW POLY 3.5 X 16MM

Facility

$9,200.00

Hospital Charge Code	270658024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.00
Max. Negotiated Rate	$4,600.00
Rate for Payer: Aetna Commercial	$2,760.00
Rate for Payer: Aetna Medicare Advantage	$2,760.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,346.00
Rate for Payer: Cigna Commercial	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,226.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.00

SCREW POLY 3.5 X 16MM

Facility

$9,200.00

Hospital Charge Code	270658024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.00
Max. Negotiated Rate	$2,226.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,226.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.00

SCREW POLY 4.75X35 1770.34.735

Facility

$5,704.00

Hospital Charge Code	270629832
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$2,852.00
Rate for Payer: Aetna Commercial	$1,711.20
Rate for Payer: Aetna Medicare Advantage	$1,711.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.52
Rate for Payer: Cigna Commercial	$2,852.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

SCREW POLY 4.75X35 1770.34.735

Facility

$5,704.00

Hospital Charge Code	270629832
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$1,380.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

SCREW POLY 5.5X35 1770.35.535

Facility

$5,704.00

Hospital Charge Code	270629831
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$2,852.00
Rate for Payer: Aetna Commercial	$1,711.20
Rate for Payer: Aetna Medicare Advantage	$1,711.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.52
Rate for Payer: Cigna Commercial	$2,852.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

SCREW POLY 5.5X35 1770.35.535

Facility

$5,704.00

Hospital Charge Code	270629831
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$1,380.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

SCREW POLY 5.5X40 1770.35.540

Facility

$5,208.00

Hospital Charge Code	270629830
Hospital Revenue Code	278
Min. Negotiated Rate	$781.20
Max. Negotiated Rate	$1,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.34
Rate for Payer: Qualcare PPO/HMO/WC	$781.20

SCREW POLY 5.5X40 1770.35.540

Facility

$5,208.00

Hospital Charge Code	270629830
Hospital Revenue Code	278
Min. Negotiated Rate	$781.20
Max. Negotiated Rate	$2,604.00
Rate for Payer: Aetna Commercial	$1,562.40
Rate for Payer: Aetna Medicare Advantage	$1,562.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.04
Rate for Payer: Cigna Commercial	$2,604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.34
Rate for Payer: Qualcare PPO/HMO/WC	$781.20

SCREW POLY 5.5X4.5MM

Facility

$8,900.00

Hospital Charge Code	270656115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$2,153.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SCREW POLY 5.5X4.5MM

Facility

$8,900.00

Hospital Charge Code	270656115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Commercial	$2,670.00
Rate for Payer: Aetna Medicare Advantage	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,269.50
Rate for Payer: Cigna Commercial	$4,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SCREW POLY 5.5X50MM

Facility

$8,900.00

Hospital Charge Code	270656116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$2,153.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SCREW POLY 5.5X50MM

Facility

$8,900.00

Hospital Charge Code	270656116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Commercial	$2,670.00
Rate for Payer: Aetna Medicare Advantage	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,269.50
Rate for Payer: Cigna Commercial	$4,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SCREW POLY 5.5x55MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270680800
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

SCREW POLY 5.5x55MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270680800
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

SCREW POLY 6.5x30mm

Facility

$8,000.00

Service Code	HCPCS C1894
Hospital Charge Code	270684969
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SCREW POLY 6.5x30mm

Facility

$8,000.00

Service Code	HCPCS C1894
Hospital Charge Code	270684969
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SCREW POLY 6.5X35MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679298
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

SCREW POLY 6.5X35MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679298
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

SCREW POLY 6.5X40MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679299
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

SCREW POLY 6.5X40MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679299
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

SCREW POLY 6.5X50mm

Facility

$8,900.00

Hospital Charge Code	70656122
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$2,153.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

SCREW POLY 6.5X50mm

Facility

$8,900.00

Hospital Charge Code	70656122
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.00
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Commercial	$2,670.00
Rate for Payer: Aetna Medicare Advantage	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,269.50
Rate for Payer: Cigna Commercial	$4,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,153.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.00

Know your out-of-pocket cost for care.

All Charges