Heights University Hospital

All Charges

Charge

Type

Setting

Price

STAGRAFT PUTTY 2CC DBM

Facility

$2,750.00

Hospital Charge Code	270703446
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

STAGRAFT PUTTY 2CC DBM

Facility

$2,750.00

Hospital Charge Code	270703446
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$825.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

STAND ALONE ACDF 14X12X6MM

Facility

$18,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270705017
Hospital Revenue Code	278
Min. Negotiated Rate	$2,787.75
Max. Negotiated Rate	$4,497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,717.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,497.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,787.75

STAND ALONE ACDF 14X12X6MM

Facility

$18,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270705017
Hospital Revenue Code	278
Min. Negotiated Rate	$2,787.75
Max. Negotiated Rate	$9,292.50
Rate for Payer: Aetna Commercial	$5,575.50
Rate for Payer: Aetna Medicare Advantage	$5,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,739.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,739.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,717.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,739.18
Rate for Payer: Cigna Commercial	$9,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,497.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,787.75

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$13,125.00
Rate for Payer: Aetna Commercial	$7,875.00
Rate for Payer: Aetna Medicare Advantage	$7,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,693.75
Rate for Payer: Cigna Commercial	$13,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704764
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$13,125.00
Rate for Payer: Aetna Commercial	$7,875.00
Rate for Payer: Aetna Medicare Advantage	$7,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,693.75
Rate for Payer: Cigna Commercial	$13,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704764
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

STAND ALONE CERVICAL 6MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270706210
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$7,775.00
Rate for Payer: Aetna Commercial	$4,665.00
Rate for Payer: Aetna Medicare Advantage	$4,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,965.25
Rate for Payer: Cigna Commercial	$7,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

STAND ALONE CERVICAL 6MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270706210
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$3,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

STAND ALONE SCREW 16MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704435
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

STAND ALONE SCREW 16MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704435
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

STAND ALONE TRUSS 12D X 15W

Facility

$12,000.00

Hospital Charge Code	270698533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

STAND ALONE TRUSS 12D X 15W

Facility

$12,000.00

Hospital Charge Code	270698533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

STANDARD GLIDEWIRE .018X 80 CM

Facility

$1,392.50

Service Code	HCPCS C1769
Hospital Charge Code	270688479
Hospital Revenue Code	272
Min. Negotiated Rate	$181.03
Max. Negotiated Rate	$696.25
Rate for Payer: Aetna Commercial	$417.75
Rate for Payer: Aetna Medicare Advantage	$417.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.09
Rate for Payer: Cigna Commercial	$696.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.03
Rate for Payer: Oxford Commercial	$696.25
Rate for Payer: Qualcare PPO/HMO/WC	$208.88
Rate for Payer: UnitedHealthcare Commercial	$696.25

STANDARD GLIDEWIRE .018X 80 CM

Facility

$1,392.50

Service Code	HCPCS C1769
Hospital Charge Code	270688479
Hospital Revenue Code	272
Min. Negotiated Rate	$208.88
Max. Negotiated Rate	$208.88
Rate for Payer: Qualcare PPO/HMO/WC	$208.88

STANDARD HUMERAL DIAPHYSIS

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STANDARD HUMERAL DIAPHYSIS

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STANDARDIZED COGNITIVE EVAL

Facility

$554.50

Service Code	HCPCS 96125GN
Hospital Charge Code	74204032
Hospital Revenue Code	444
Min. Negotiated Rate	$72.08
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$166.35
Rate for Payer: Aetna Medicare Advantage	$166.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.40
Rate for Payer: Cigna Commercial	$277.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.08
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.17
Rate for Payer: UnitedHealthcare Commercial	$686.00

STANDARDIZED COGNITIVE EVAL

Facility

$554.50

Service Code	HCPCS 96125GN
Hospital Charge Code	74204032
Hospital Revenue Code	444
Min. Negotiated Rate	$83.17
Max. Negotiated Rate	$83.17
Rate for Payer: Qualcare PPO/HMO/WC	$83.17

STANDARD KIT

Facility

$2,075.00

Hospital Charge Code	270659845
Hospital Revenue Code	272
Min. Negotiated Rate	$269.75
Max. Negotiated Rate	$1,037.50
Rate for Payer: Aetna Commercial	$622.50
Rate for Payer: Aetna Medicare Advantage	$622.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$529.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$529.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$529.12
Rate for Payer: Cigna Commercial	$1,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.75
Rate for Payer: Oxford Commercial	$1,037.50
Rate for Payer: Qualcare PPO/HMO/WC	$311.25
Rate for Payer: UnitedHealthcare Commercial	$1,037.50

STANDARD KIT

Facility

$2,075.00

Hospital Charge Code	270659845
Hospital Revenue Code	272
Min. Negotiated Rate	$311.25
Max. Negotiated Rate	$311.25
Rate for Payer: Qualcare PPO/HMO/WC	$311.25

STANDARD POLY LINER SZ 9

Facility

$9,860.25

Service Code	HCPCS C1776
Hospital Charge Code	270688863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.04
Max. Negotiated Rate	$4,930.12
Rate for Payer: Aetna Commercial	$2,958.07
Rate for Payer: Aetna Medicare Advantage	$2,958.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.36
Rate for Payer: Cigna Commercial	$4,930.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.04

STANDARD POLY LINER SZ 9

Facility

$9,860.25

Service Code	HCPCS C1776
Hospital Charge Code	270688863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.04
Max. Negotiated Rate	$2,386.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.04

STANDBY PROCEDURE ATS500

Facility

$1,364.00

Hospital Charge Code	270633101
Hospital Revenue Code	272
Min. Negotiated Rate	$177.32
Max. Negotiated Rate	$682.00
Rate for Payer: Aetna Commercial	$409.20
Rate for Payer: Aetna Medicare Advantage	$409.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.82
Rate for Payer: Cigna Commercial	$682.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.32
Rate for Payer: Oxford Commercial	$682.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.60
Rate for Payer: UnitedHealthcare Commercial	$682.00

Know your out-of-pocket cost for care.

All Charges