Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW SET MARINER 41-1010

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693229
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

SCREW SET MARINER 41-1010

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693229
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

SCREW SET OVERWATCH

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270692589
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

SCREW SET OVERWATCH

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270692589
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

SCREW SET PEDICLE

Facility

$1,750.00

Hospital Charge Code	270680079
Hospital Revenue Code	272
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$875.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$875.00

SCREW SET PEDICLE

Facility

$1,750.00

Hospital Charge Code	270680079
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

SCREW SET SAVANNAH-T

Facility

$2,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270656140
Hospital Revenue Code	278
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$1,190.00
Rate for Payer: Aetna Commercial	$714.00
Rate for Payer: Aetna Medicare Advantage	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$606.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$606.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$476.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$606.90
Rate for Payer: Cigna Commercial	$1,190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$575.96
Rate for Payer: Qualcare PPO/HMO/WC	$357.00

SCREW SET SAVANNAH-T

Facility

$2,380.00

Service Code	HCPCS C1713
Hospital Charge Code	270656140
Hospital Revenue Code	278
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$575.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$476.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$575.96
Rate for Payer: Qualcare PPO/HMO/WC	$357.00

SCREW SET SINGLE INNER

Facility

$1,775.00

Hospital Charge Code	270665208
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$429.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

SCREW SET SINGLE INNER

Facility

$1,775.00

Hospital Charge Code	270665208
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$887.50
Rate for Payer: Aetna Commercial	$532.50
Rate for Payer: Aetna Medicare Advantage	$532.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.62
Rate for Payer: Cigna Commercial	$887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

SCREW SET SPINE 4.75MM TI CAP

Facility

$1,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270696281
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$547.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

SCREW SET SPINE 4.75MM TI CAP

Facility

$1,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270696281
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

SCREW SET SYMPHONY

Facility

$1,045.50

Service Code	HCPCS C1713
Hospital Charge Code	270693341
Hospital Revenue Code	278
Min. Negotiated Rate	$156.82
Max. Negotiated Rate	$253.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.01
Rate for Payer: Qualcare PPO/HMO/WC	$156.82

SCREW SET SYMPHONY

Facility

$1,045.50

Service Code	HCPCS C1713
Hospital Charge Code	270693341
Hospital Revenue Code	278
Min. Negotiated Rate	$156.82
Max. Negotiated Rate	$522.75
Rate for Payer: Aetna Commercial	$313.65
Rate for Payer: Aetna Medicare Advantage	$313.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.60
Rate for Payer: Cigna Commercial	$522.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.01
Rate for Payer: Qualcare PPO/HMO/WC	$156.82

SCREW SET T25 5.5/6.0 TULIP

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270693913
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SCREW SET T25 5.5/6.0 TULIP

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270693913
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SCREW SET T25 LOCKING CAP

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270692672
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SCREW SET T25 LOCKING CAP

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270692672
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SCREW SET TALL SYMPHONY

Facility

$1,045.50

Service Code	HCPCS C1713
Hospital Charge Code	270693340
Hospital Revenue Code	278
Min. Negotiated Rate	$156.82
Max. Negotiated Rate	$522.75
Rate for Payer: Aetna Commercial	$313.65
Rate for Payer: Aetna Medicare Advantage	$313.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.60
Rate for Payer: Cigna Commercial	$522.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.01
Rate for Payer: Qualcare PPO/HMO/WC	$156.82

SCREW SET TALL SYMPHONY

Facility

$1,045.50

Service Code	HCPCS C1713
Hospital Charge Code	270693340
Hospital Revenue Code	278
Min. Negotiated Rate	$156.82
Max. Negotiated Rate	$253.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.01
Rate for Payer: Qualcare PPO/HMO/WC	$156.82

SCREW SET THUNDERBOLT 5.5MM

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270695216
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SCREW SET THUNDERBOLT 5.5MM

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270695216
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SCREW SET VOYAGER MAS 5.5X60MM

Facility

$1,495.00

Service Code	HCPCS C1713
Hospital Charge Code	270699079
Hospital Revenue Code	278
Min. Negotiated Rate	$224.25
Max. Negotiated Rate	$747.50
Rate for Payer: Aetna Commercial	$448.50
Rate for Payer: Aetna Medicare Advantage	$448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$381.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$381.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$381.23
Rate for Payer: Cigna Commercial	$747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.79
Rate for Payer: Qualcare PPO/HMO/WC	$224.25

SCREW SET VOYAGER MAS 5.5X60MM

Facility

$1,495.00

Service Code	HCPCS C1713
Hospital Charge Code	270699079
Hospital Revenue Code	278
Min. Negotiated Rate	$224.25
Max. Negotiated Rate	$361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.79
Rate for Payer: Qualcare PPO/HMO/WC	$224.25

SCREW S-FIX 2.5 X14 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270689578
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

Know your out-of-pocket cost for care.

All Charges