Heights University Hospital

All Charges

Charge

Type

Setting

Price

WEDGE BIOCORTICAL COTTON 6MM

Facility

$7,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270684863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,073.25
Max. Negotiated Rate	$1,731.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,431.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,731.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,073.25

WEDGE BIOCORTICAL COTTON 6MM

Facility

$7,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270684863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,073.25
Max. Negotiated Rate	$3,577.50
Rate for Payer: Aetna Commercial	$2,146.50
Rate for Payer: Aetna Medicare Advantage	$2,146.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,824.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,824.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,824.53
Rate for Payer: Cigna Commercial	$3,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,731.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,073.25

WEDGE BIOCORTICAL EVANS 8MM

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270684862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$2,116.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

WEDGE BIOCORTICAL EVANS 8MM

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270684862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$4,372.50
Rate for Payer: Aetna Commercial	$2,623.50
Rate for Payer: Aetna Medicare Advantage	$2,623.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.97
Rate for Payer: Cigna Commercial	$4,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

WEDGE BIOFOAM 16X4.5MM

Facility

$11,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270700553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,769.25
Max. Negotiated Rate	$2,854.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,769.25

WEDGE BIOFOAM 16X4.5MM

Facility

$11,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270700553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,769.25
Max. Negotiated Rate	$5,897.50
Rate for Payer: Aetna Commercial	$3,538.50
Rate for Payer: Aetna Medicare Advantage	$3,538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,007.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,007.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,007.72
Rate for Payer: Cigna Commercial	$5,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,769.25

WEDGE BIOSYNC 18X18X8MM

Facility

$10,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270693396
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.25
Max. Negotiated Rate	$5,487.50
Rate for Payer: Aetna Commercial	$3,292.50
Rate for Payer: Aetna Medicare Advantage	$3,292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,798.62
Rate for Payer: Cigna Commercial	$5,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25

WEDGE BIOSYNC 18X18X8MM

Facility

$10,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270693396
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.25
Max. Negotiated Rate	$2,655.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25

WEDGE BIOSYNC 20X 5.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690273
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE BIOSYNC 20X 5.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690273
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE BIOSYNC SET

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687871
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

WEDGE BIOSYNC SET

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687871
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

WEDGE BONE TANGNT 10X26 171026

Facility

$6,834.45

Hospital Charge Code	270618697
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.17
Max. Negotiated Rate	$1,653.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,366.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,653.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.17

WEDGE BONE TANGNT 10X26 171026

Facility

$6,834.45

Hospital Charge Code	270618697
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.17
Max. Negotiated Rate	$3,417.22
Rate for Payer: Aetna Commercial	$2,050.34
Rate for Payer: Aetna Medicare Advantage	$2,050.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,366.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,742.78
Rate for Payer: Cigna Commercial	$3,417.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,653.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.17

WEDGE BONE TANGNT 8X20 170820

Facility

$6,834.45

Hospital Charge Code	270618696
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.17
Max. Negotiated Rate	$1,653.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,366.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,653.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.17

WEDGE BONE TANGNT 8X20 170820

Facility

$6,834.45

Hospital Charge Code	270618696
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.17
Max. Negotiated Rate	$3,417.22
Rate for Payer: Aetna Commercial	$2,050.34
Rate for Payer: Aetna Medicare Advantage	$2,050.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,366.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,742.78
Rate for Payer: Cigna Commercial	$3,417.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,653.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.17

WEDGE CANCELLOUS BONE 206002

Facility

$5,456.00

Hospital Charge Code	270630021
Hospital Revenue Code	278
Min. Negotiated Rate	$818.40
Max. Negotiated Rate	$2,728.00
Rate for Payer: Aetna Commercial	$1,636.80
Rate for Payer: Aetna Medicare Advantage	$1,636.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,391.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,391.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,091.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,391.28
Rate for Payer: Cigna Commercial	$2,728.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.35
Rate for Payer: Qualcare PPO/HMO/WC	$818.40

WEDGE CANCELLOUS BONE 206002

Facility

$5,456.00

Hospital Charge Code	270630021
Hospital Revenue Code	278
Min. Negotiated Rate	$818.40
Max. Negotiated Rate	$1,320.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,091.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.35
Rate for Payer: Qualcare PPO/HMO/WC	$818.40

WEDGE COTTN CONSTRUCT T AND I

Facility

$16,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701839
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

WEDGE COTTN CONSTRUCT T AND I

Facility

$16,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701839
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

WEDGE COTTON

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687703
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687703
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON 16 5.5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270686656
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON 16 5.5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270686656
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

WEDGE COTTON 16 X5 MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

Know your out-of-pocket cost for care.

All Charges