Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$6,740.00
Rate for Payer: Aetna Commercial	$4,044.00
Rate for Payer: Aetna Medicare Advantage	$4,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,437.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,437.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,437.40
Rate for Payer: Cigna Commercial	$6,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,262.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.00

SCREW POLYAXIAL TI 9.5X50MM

Facility

$13,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270695682
Hospital Revenue Code	278
Min. Negotiated Rate	$2,022.00
Max. Negotiated Rate	$6,740.00
Rate for Payer: Aetna Commercial	$4,044.00
Rate for Payer: Aetna Medicare Advantage	$4,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,437.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,437.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,437.40
Rate for Payer: Cigna Commercial	$6,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,262.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.00

SCREW POLYAXIAL TI 9.5X50MM

Facility

$13,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270695682
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 POLY AXL 7x30mm

Facility

$9,825.00

Hospital Charge Code	270665206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$2,377.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75

SCREW POLY AXL 7x30mm

Facility

$9,825.00

Hospital Charge Code	270665206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$4,912.50
Rate for Payer: Aetna Commercial	$2,947.50
Rate for Payer: Aetna Medicare Advantage	$2,947.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,505.38
Rate for Payer: Cigna Commercial	$4,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75

SCREW POLYAX LKG MINI 2.0X10MM

Facility

$975.00

Service Code	HCPCS C1713
Hospital Charge Code	270697023
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SCREW POLYAX LKG MINI 2.0X10MM

Facility

$975.00

Service Code	HCPCS C1713
Hospital Charge Code	270697023
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SCREW POLYAX LKG MINI 2.0X12MM

Facility

$975.00

Service Code	HCPCS C1713
Hospital Charge Code	270697022
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SCREW POLYAX LKG MINI 2.0X12MM

Facility

$975.00

Service Code	HCPCS C1713
Hospital Charge Code	270697022
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SCREW POLYAXL SI 4.35x40MM

Facility

$5,500.00

Hospital Charge Code	270666210
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 POLYAXL SI 4.35x40MM

Facility

$5,500.00

Hospital Charge Code	270666210
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 POLYAXL SI 4.35x45MM

Facility

$5,500.00

Hospital Charge Code	270670553
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 POLYAXL SI 4.35x45MM

Facility

$5,500.00

Hospital Charge Code	270670553
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 POLYAXL SI 5x45MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270669372
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 POLYAXL SI 5x45MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270669372
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 POLYAXL SI 5x50MM

Facility

$5,500.00

Hospital Charge Code	270667961
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 POLYAXL SI 5x50MM

Facility

$5,500.00

Hospital Charge Code	270667961
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 POLYAXL SI 5x55MM

Facility

$5,500.00

Hospital Charge Code	270667962
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 POLYAXL SI 5x55MM

Facility

$5,500.00

Hospital Charge Code	270667962
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 POLYAXL SI 6x40MM

Facility

$5,500.00

Hospital Charge Code	270659815
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 POLYAXL SI 6x40MM

Facility

$5,500.00

Hospital Charge Code	270659815
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 POLYAXL SI 6x45MM

Facility

$5,500.00

Hospital Charge Code	270659156
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 POLYAXL SI 6x45MM

Facility

$5,500.00

Hospital Charge Code	270659156
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 POLYAXL SI 6x50MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270659849
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 POLYAXL SI 6x50MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270659849
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Aetna Commercial	$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

Know your out-of-pocket cost for care.

All Charges