Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW POLYAXIAL 6.5 X 40 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691422
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 40 MM

Facility

$10,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270691422
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

SCREW POLYAXIAL 6.5 X 45 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694185
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 POLYAXIAL 6.5 X 45 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,022.00
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL 65X45MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705779
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

SCREW POLYAXIAL 65X45MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705779
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

SCREW POLYAXIAL 7.5 MM X 80 MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685951
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 POLYAXIAL 7.5 MM X 80 MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685951
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 POLYAXIAL 7.5X35MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695325
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 POLYAXIAL 7.5X35MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,022.00
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL 7.5X 40 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,022.00
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL 7.5X 40 MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270694186
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 POLYAXIAL 7.5X45 MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270692204
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$1,898.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

SCREW POLYAXIAL 7.5X45 MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270692204
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$3,922.50
Rate for Payer: Aetna Commercial	$2,353.50
Rate for Payer: Aetna Medicare Advantage	$2,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.47
Rate for Payer: Cigna Commercial	$3,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

SCREW POLYAXIAL 7.5X 70MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685950
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 POLYAXIAL 7.5X 70MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685950
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 POLYAXIAL 8.5X45MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695324
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 POLYAXIAL 8.5X45MM

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695324
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,022.00
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

SCREW POLYAXIAL NL TI 3.5X24MM

Facility

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	270698956
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Commercial	$283.50
Rate for Payer: Aetna Medicare Advantage	$283.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.97
Rate for Payer: Cigna Commercial	$472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.69
Rate for Payer: Qualcare PPO/HMO/WC	$141.75

SCREW POLYAXIAL NL TI 3.5X24MM

Facility

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	270698956
Hospital Revenue Code	278
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$228.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.69
Rate for Payer: Qualcare PPO/HMO/WC	$141.75

SCREW POLYAXIAL TBOLT 6.5X45MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW POLYAXIAL TBOLT 6.5X45MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW POLYAXIAL TBOLT 7.5X30MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW POLYAXIAL TBOLT 7.5X30MM

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW POLYAXIAL TI 7.5X45MM

Facility

$13,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270695681
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

Know your out-of-pocket cost for care.

All Charges