Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPACER PEEK IMPLANT 11X11X7

Facility

$10,675.00

Service Code	HCPCS L8699
Hospital Charge Code	270648860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$3,202.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

SPACER PEEK IMPLANT 11X11X7

Facility

$10,675.00

Service Code	HCPCS L8699
Hospital Charge Code	270648860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

SPACER PEEK INTERB 7X13X16MM7D

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695374
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPACER PEEK INTERB 7X13X16MM7D

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695374
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPACER PEEK OPT TI 14X12X7MM

Facility

$5,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SPACER PEEK OPT TI 14X12X7MM

Facility

$5,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SPACER PLIF 11X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694810
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$6,150.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF 11X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694810
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF 13X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694811
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF 13X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694811
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$6,150.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF ZFUZE 12X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695411
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$6,150.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF ZFUZE 12X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695411
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER POLY TIBIAL 20MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270682844
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$4,282.50
Rate for Payer: Aetna Commercial	$2,569.50
Rate for Payer: Aetna Medicare Advantage	$2,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,184.07
Rate for Payer: Cigna Commercial	$4,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SPACER POLY TIBIAL 20MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270682844
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$2,072.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SPACER SABLE 10X22X6MM 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693833
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$11,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X22X6MM 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693833
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X26 7-14MM 15D

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693237
Hospital Revenue Code	278
Min. Negotiated Rate	$8,625.00
Max. Negotiated Rate	$28,750.00
Rate for Payer: Aetna Commercial	$17,250.00
Rate for Payer: Aetna Medicare Advantage	$17,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,662.50
Rate for Payer: Cigna Commercial	$28,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00

SPACER SABLE 10X26 7-14MM 15D

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693237
Hospital Revenue Code	278
Min. Negotiated Rate	$8,625.00
Max. Negotiated Rate	$13,915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00

SPACER SABLE 10X26 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693489
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X26 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693489
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$11,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SDK DYNLOK 4.0 843.165

Facility

$368.85

Hospital Charge Code	270616296
Hospital Revenue Code	272
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$184.43
Rate for Payer: Aetna Commercial	$110.66
Rate for Payer: Aetna Medicare Advantage	$110.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.06
Rate for Payer: Cigna Commercial	$184.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.95
Rate for Payer: Oxford Commercial	$184.43
Rate for Payer: Qualcare PPO/HMO/WC	$55.33
Rate for Payer: UnitedHealthcare Commercial	$184.43

SPACER SDK DYNLOK 4.0 843.165

Facility

$368.85

Hospital Charge Code	270616296
Hospital Revenue Code	272
Min. Negotiated Rate	$55.33
Max. Negotiated Rate	$55.33
Rate for Payer: Qualcare PPO/HMO/WC	$55.33

SPACERS (FOR RADIUM SEED)

Facility

$126.00

Hospital Charge Code	270335234
Hospital Revenue Code	278
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$30.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

SPACERS (FOR RADIUM SEED)

Facility

$126.00

Hospital Charge Code	270335234
Hospital Revenue Code	278
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$37.80
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

SPACER SIDE RAIL

Facility

$77.00

Hospital Charge Code	270679661
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

Know your out-of-pocket cost for care.

All Charges