Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCRW 2.7x26 NON-LOCK 53-27226E

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270647779
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SCRW 2.7x26 NON-LOCK 53-27226E

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270647779
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SCRW 3.5x14 LPNLCK 1312-18-014

Facility

$370.00

Hospital Charge Code	270661587
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$111.00
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x14 LPNLCK 1312-18-014

Facility

$370.00

Hospital Charge Code	270661587
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x16 LPNLCK 1312-18-016

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661582
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$111.00
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x16 LPNLCK 1312-18-016

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661582
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x18 LPNLCK 1312-18-018

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661583
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$111.00
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x18 LPNLCK 1312-18-018

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661583
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x24 LP NLCK1312-18-024

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658896
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x24 LP NLCK1312-18-024

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658896
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x26 LPNLCK 1312-18-026

Facility

$350.00

Hospital Charge Code	270658890
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x26 LPNLCK 1312-18-026

Facility

$350.00

Hospital Charge Code	270658890
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x28 LP NLCK1312-18-028

Facility

$350.00

Hospital Charge Code	270658898
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x28 LP NLCK1312-18-028

Facility

$350.00

Hospital Charge Code	270658898
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x30 LP NLCK1312-18-030

Facility

$350.00

Hospital Charge Code	270658899
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x30 LP NLCK1312-18-030

Facility

$350.00

Hospital Charge Code	270658899
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x34 LP NLCK1312-18-034

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658895
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x34 LP NLCK1312-18-034

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658895
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x36 LPNLCK 1312-18-036

Facility

$350.00

Hospital Charge Code	270658892
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x36 LPNLCK 1312-18-036

Facility

$350.00

Hospital Charge Code	270658892
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x65 LP NLCK1312-18-065

Facility

$350.00

Hospital Charge Code	270658894
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x65 LP NLCK1312-18-065

Facility

$350.00

Hospital Charge Code	270658894
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 4.0X12 CNCLCK 8161-40-012

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661580
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCRW 4.0X12 CNCLCK 8161-40-012

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270661580
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCRW 4.0X14 CNCLCK 8161-40-014

Facility

$632.50

Service Code	HCPCS C1713
Hospital Charge Code	270661577
Hospital Revenue Code	278
Min. Negotiated Rate	$94.88
Max. Negotiated Rate	$153.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.06
Rate for Payer: Qualcare PPO/HMO/WC	$94.88

Know your out-of-pocket cost for care.

All Charges