Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREW TIBIAL INSERT SZ3 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680593
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ3 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680593
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ3 30MM

Facility

$6,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270677685
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$3,475.00
Rate for Payer: Aetna Commercial	$2,085.00
Rate for Payer: Aetna Medicare Advantage	$2,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,772.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,772.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,772.25
Rate for Payer: Cigna Commercial	$3,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,042.50

SCREW TIBIAL INSERT SZ3 30MM

Facility

$6,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270677685
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$1,681.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,042.50

SCREW TIBIAL INSERT SZ4 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270679485
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ4 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270679485
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ4 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680025
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ4 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680025
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ5 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270676684
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ5 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270676684
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL SCREW SZ4 26MM

Facility

$6,503.00

Service Code	HCPCS C1713
Hospital Charge Code	270676556
Hospital Revenue Code	278
Min. Negotiated Rate	$975.45
Max. Negotiated Rate	$1,573.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.73
Rate for Payer: Qualcare PPO/HMO/WC	$975.45

SCREW TIBIAL SCREW SZ4 26MM

Facility

$6,503.00

Service Code	HCPCS C1713
Hospital Charge Code	270676556
Hospital Revenue Code	278
Min. Negotiated Rate	$975.45
Max. Negotiated Rate	$3,251.50
Rate for Payer: Aetna Commercial	$1,950.90
Rate for Payer: Aetna Medicare Advantage	$1,950.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,658.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,658.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,658.27
Rate for Payer: Cigna Commercial	$3,251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.73
Rate for Payer: Qualcare PPO/HMO/WC	$975.45

SCREW TIBIAL STEM EXTERNSION

Facility

$506.50

Service Code	HCPCS C1713
Hospital Charge Code	270671719
Hospital Revenue Code	278
Min. Negotiated Rate	$75.97
Max. Negotiated Rate	$253.25
Rate for Payer: Aetna Commercial	$151.95
Rate for Payer: Aetna Medicare Advantage	$151.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.16
Rate for Payer: Cigna Commercial	$253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.57
Rate for Payer: Qualcare PPO/HMO/WC	$75.97

SCREW TIBIAL STEM EXTERNSION

Facility

$506.50

Service Code	HCPCS C1713
Hospital Charge Code	270671719
Hospital Revenue Code	278
Min. Negotiated Rate	$75.97
Max. Negotiated Rate	$122.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.57
Rate for Payer: Qualcare PPO/HMO/WC	$75.97

SCREW TI CAN CMP HDLS 4.5X24MM

Facility

$5,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270700711
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

SCREW TI CAN CMP HDLS 4.5X24MM

Facility

$5,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270700711
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$1,612.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

SCREW TI CAN CMP HDLS 5.5 ST32

Facility

$1,882.50

Service Code	HCPCS C1713
Hospital Charge Code	270695360
Hospital Revenue Code	278
Min. Negotiated Rate	$282.38
Max. Negotiated Rate	$941.25
Rate for Payer: Aetna Commercial	$564.75
Rate for Payer: Aetna Medicare Advantage	$564.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$480.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$480.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$480.04
Rate for Payer: Cigna Commercial	$941.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.56
Rate for Payer: Qualcare PPO/HMO/WC	$282.38

SCREW TI CAN CMP HDLS 5.5 ST32

Facility

$1,882.50

Service Code	HCPCS C1713
Hospital Charge Code	270695360
Hospital Revenue Code	278
Min. Negotiated Rate	$282.38
Max. Negotiated Rate	$455.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.56
Rate for Payer: Qualcare PPO/HMO/WC	$282.38

SCREW TI CAN CMP HDLS 5.5 ST34

Facility

$3,382.50

Service Code	HCPCS C1713
Hospital Charge Code	270695361
Hospital Revenue Code	278
Min. Negotiated Rate	$507.38
Max. Negotiated Rate	$818.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$818.57
Rate for Payer: Qualcare PPO/HMO/WC	$507.38

SCREW TI CAN CMP HDLS 5.5 ST34

Facility

$3,382.50

Service Code	HCPCS C1713
Hospital Charge Code	270695361
Hospital Revenue Code	278
Min. Negotiated Rate	$507.38
Max. Negotiated Rate	$1,691.25
Rate for Payer: Aetna Commercial	$1,014.75
Rate for Payer: Aetna Medicare Advantage	$1,014.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$862.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$862.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$862.54
Rate for Payer: Cigna Commercial	$1,691.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$818.57
Rate for Payer: Qualcare PPO/HMO/WC	$507.38

SCREW TI CAN CMP HDLS 5.5 ST40

Facility

$3,382.50

Service Code	HCPCS C1713
Hospital Charge Code	270695362
Hospital Revenue Code	278
Min. Negotiated Rate	$507.38
Max. Negotiated Rate	$1,691.25
Rate for Payer: Aetna Commercial	$1,014.75
Rate for Payer: Aetna Medicare Advantage	$1,014.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$862.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$862.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$862.54
Rate for Payer: Cigna Commercial	$1,691.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$818.57
Rate for Payer: Qualcare PPO/HMO/WC	$507.38

SCREW TI CAN CMP HDLS 5.5 ST40

Facility

$3,382.50

Service Code	HCPCS C1713
Hospital Charge Code	270695362
Hospital Revenue Code	278
Min. Negotiated Rate	$507.38
Max. Negotiated Rate	$818.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$818.57
Rate for Payer: Qualcare PPO/HMO/WC	$507.38

SCREW TI CAN CMP HDLS 6.5 ST32

Facility

$3,382.50

Service Code	HCPCS C1713
Hospital Charge Code	270695359
Hospital Revenue Code	278
Min. Negotiated Rate	$507.38
Max. Negotiated Rate	$1,691.25
Rate for Payer: Aetna Commercial	$1,014.75
Rate for Payer: Aetna Medicare Advantage	$1,014.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$862.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$862.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$862.54
Rate for Payer: Cigna Commercial	$1,691.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$818.57
Rate for Payer: Qualcare PPO/HMO/WC	$507.38

SCREW TI CAN CMP HDLS 6.5 ST32

Facility

$3,382.50

Service Code	HCPCS C1713
Hospital Charge Code	270695359
Hospital Revenue Code	278
Min. Negotiated Rate	$507.38
Max. Negotiated Rate	$818.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$818.57
Rate for Payer: Qualcare PPO/HMO/WC	$507.38

SCREWTICANCOMPHDLSST2.5X28MM

Facility

$4,780.00

Service Code	HCPCS C1713
Hospital Charge Code	270700201
Hospital Revenue Code	278
Min. Negotiated Rate	$717.00
Max. Negotiated Rate	$2,390.00
Rate for Payer: Aetna Commercial	$1,434.00
Rate for Payer: Aetna Medicare Advantage	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.90
Rate for Payer: Cigna Commercial	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.76
Rate for Payer: Qualcare PPO/HMO/WC	$717.00

Know your out-of-pocket cost for care.

All Charges