Heights University Hospital

All Charges

Charge

Type

Setting

Price

SET RADIATION TX FIELD-TC

Facility

$1,656.90

Service Code	HCPCS 77285TC
Hospital Charge Code	85000405
Hospital Revenue Code	333
Min. Negotiated Rate	$215.40
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$497.07
Rate for Payer: Aetna Medicare Advantage	$497.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.51
Rate for Payer: Cigna Commercial	$828.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.40
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.53
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

SET RENAL DILATOR 8F 30Fx35cm

Facility

$2,101.35

Service Code	HCPCS C1894
Hospital Charge Code	270627868
Hospital Revenue Code	278
Min. Negotiated Rate	$315.20
Max. Negotiated Rate	$1,050.67
Rate for Payer: Aetna Commercial	$630.40
Rate for Payer: Aetna Medicare Advantage	$630.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.84
Rate for Payer: Cigna Commercial	$1,050.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.53
Rate for Payer: Qualcare PPO/HMO/WC	$315.20

SET RENAL DILATOR 8F 30Fx35cm

Facility

$2,101.35

Service Code	HCPCS C1894
Hospital Charge Code	270627868
Hospital Revenue Code	278
Min. Negotiated Rate	$315.20
Max. Negotiated Rate	$508.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.53
Rate for Payer: Qualcare PPO/HMO/WC	$315.20

SET RESPIRATORY TRANSFER***

Facility

$8.00

Hospital Charge Code	9501131
Hospital Revenue Code	279
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

SET RESPIRATORY TRANSFER***

Facility

$8.00

Hospital Charge Code	9501131
Hospital Revenue Code	279
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705429
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705429
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW

Facility

$2,845.00

Hospital Charge Code	270702579
Hospital Revenue Code	278
Min. Negotiated Rate	$426.75
Max. Negotiated Rate	$688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: Qualcare PPO/HMO/WC	$426.75

SET SCREW

Facility

$625.00

Hospital Charge Code	270701731
Hospital Revenue Code	270
Min. Negotiated Rate	$81.25
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

SET SCREW

Facility

$2,900.00

Hospital Charge Code	270662645
Hospital Revenue Code	278
Min. Negotiated Rate	$435.00
Max. Negotiated Rate	$701.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.80
Rate for Payer: Qualcare PPO/HMO/WC	$435.00

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681776
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW

Facility

$2,900.00

Hospital Charge Code	270662645
Hospital Revenue Code	278
Min. Negotiated Rate	$435.00
Max. Negotiated Rate	$1,450.00
Rate for Payer: Aetna Commercial	$870.00
Rate for Payer: Aetna Medicare Advantage	$870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$739.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$739.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$739.50
Rate for Payer: Cigna Commercial	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.80
Rate for Payer: Qualcare PPO/HMO/WC	$435.00

SET SCREW

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704448
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

SET SCREW

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704448
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

SET SCREW

Facility

$2,845.00

Hospital Charge Code	270702579
Hospital Revenue Code	278
Min. Negotiated Rate	$426.75
Max. Negotiated Rate	$1,422.50
Rate for Payer: Aetna Commercial	$853.50
Rate for Payer: Aetna Medicare Advantage	$853.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.48
Rate for Payer: Cigna Commercial	$1,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: Qualcare PPO/HMO/WC	$426.75

SET SCREW

Facility

$625.00

Hospital Charge Code	270701731
Hospital Revenue Code	270
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681776
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW #11-4001

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705470
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SET SCREW #11-4001

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705470
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SET SCREW EVEREST POLYAXIAL

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270670411
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW EVEREST POLYAXIAL

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270670411
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW LATERAL PLATE NEXXT

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693626
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

SET SCREW LATERAL PLATE NEXXT

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693626
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

SET SCREW M8 BREAK OFF 8590855

Facility

$674.65

Hospital Charge Code	270630622
Hospital Revenue Code	278
Min. Negotiated Rate	$101.20
Max. Negotiated Rate	$337.32
Rate for Payer: Aetna Commercial	$202.40
Rate for Payer: Aetna Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.04
Rate for Payer: Cigna Commercial	$337.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.27
Rate for Payer: Qualcare PPO/HMO/WC	$101.20

SET SCREW M8 BREAK OFF 8590855

Facility

$674.65

Hospital Charge Code	270630622
Hospital Revenue Code	278
Min. Negotiated Rate	$101.20
Max. Negotiated Rate	$163.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.27
Rate for Payer: Qualcare PPO/HMO/WC	$101.20

Know your out-of-pocket cost for care.

All Charges