Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW POLYAXIAL 28X3.5MM

Facility

$13,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270691933
Hospital Revenue Code	278
Min. Negotiated Rate	$2,022.00
Max. Negotiated Rate	$3,262.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,262.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.00

SCREW POLYAXIAL 3.5X12MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694468
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X12MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694468
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X18MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270695314
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SCREW POLYAXIAL 3.5X18MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270695314
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SCREW POLYAXIAL 3.5X20MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694469
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X20MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694469
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X22MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697053
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X22MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697053
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X24MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694470
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X24MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694470
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SCREW POLYAXIAL 3.5X26MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270697498
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SCREW POLYAXIAL 3.5X26MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270697498
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SCREW POLYAXIAL 3.5X30MM

Facility

$3,500.00

Hospital Charge Code	270702357
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

SCREW POLYAXIAL 3.5X30MM

Facility

$3,500.00

Hospital Charge Code	270702357
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

SCREW POLYAXIAL 4.0X12MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270695315
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SCREW POLYAXIAL 4.0X12MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270695315
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SCREW POLYAXIAL 4.5X26MM

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704861
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

SCREW POLYAXIAL 4.5X26MM

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704861
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

SCREW POLYAXIAL 5.5MM X 45M

Facility

$8,900.00

Hospital Charge Code	270661265
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 POLYAXIAL 5.5MM X 45M

Facility

$8,900.00

Hospital Charge Code	270661265
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 POLYAXIAL 6.5 MM X 45 MM

Facility

$5,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270691013
Hospital Revenue Code	278
Min. Negotiated Rate	$813.75
Max. Negotiated Rate	$2,712.50
Rate for Payer: Aetna Commercial	$1,627.50
Rate for Payer: Aetna Medicare Advantage	$1,627.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,383.38
Rate for Payer: Cigna Commercial	$2,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: Qualcare PPO/HMO/WC	$813.75

SCREW POLYAXIAL 6.5 MM X 45 MM

Facility

$5,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270691013
Hospital Revenue Code	278
Min. Negotiated Rate	$813.75
Max. Negotiated Rate	$1,312.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: Qualcare PPO/HMO/WC	$813.75

SCREW POLYAXIAL 6.5 X 30 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,628.25
Max. Negotiated Rate	$2,626.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.25

SCREW POLYAXIAL 6.5 X 30 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,628.25
Max. Negotiated Rate	$5,427.50
Rate for Payer: Aetna Commercial	$3,256.50
Rate for Payer: Aetna Medicare Advantage	$3,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,768.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,768.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,768.03
Rate for Payer: Cigna Commercial	$5,427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.25

Know your out-of-pocket cost for care.

All Charges