Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 5MM 403205

Facility

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270677907
Hospital Revenue Code	278
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$1,219.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,008.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,219.68
Rate for Payer: Qualcare PPO/HMO/WC	$756.00

WEDGE COTTON 5MM 403205

Facility

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270677907
Hospital Revenue Code	278
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$2,520.00
Rate for Payer: Aetna Commercial	$1,512.00
Rate for Payer: Aetna Medicare Advantage	$1,512.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,008.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,285.20
Rate for Payer: Cigna Commercial	$2,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,219.68
Rate for Payer: Qualcare PPO/HMO/WC	$756.00

WEDGE COTTON ALLOGRAFT 7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697528
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WEDGE COTTON ALLOGRAFT 7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697528
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WEDGE COTTON BIOSYNC 20X7.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694507
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 BIOSYNC 20X7.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694507
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 BIOSYNE 16X 6.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270688028
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 BIOSYNE 16X 6.5MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270688028
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 RIPTIDE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697162
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

WEDGE COTTON RIPTIDE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697162
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$5,850.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

WEDGE EVANS 18X18 6.5MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687448
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 EVANS 18X18 6.5MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687448
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 EVANS 20X 20X 6 MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687073
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 EVANS 20X 20X 6 MM

Facility

$10,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270687073
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 EVANS 6MM

Facility

$6,100.00

Hospital Charge Code	270677906
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$3,050.00
Rate for Payer: Aetna Commercial	$1,830.00
Rate for Payer: Aetna Medicare Advantage	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,555.50
Rate for Payer: Cigna Commercial	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

WEDGE EVANS 6MM

Facility

$6,100.00

Hospital Charge Code	270677906
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,476.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

WEDGE EVANS PURP 18x18MM 8MM

Facility

$8,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270675133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.75
Max. Negotiated Rate	$4,452.50
Rate for Payer: Aetna Commercial	$2,671.50
Rate for Payer: Aetna Medicare Advantage	$2,671.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.78
Rate for Payer: Cigna Commercial	$4,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,155.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.75

WEDGE EVANS PURP 18x18MM 8MM

Facility

$8,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270675133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.75
Max. Negotiated Rate	$2,155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,781.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,155.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.75

WEDGE FEMORAL DISTAL 3 X 5MM

Facility

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	270687753
Hospital Revenue Code	278
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

WEDGE FEMORAL DISTAL 3 X 5MM

Facility

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	270687753
Hospital Revenue Code	278
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

WEDGE FIBULAR 6MM 500418

Facility

$1,900.00

Hospital Charge Code	270616214
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$950.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.50
Rate for Payer: Cigna Commercial	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.80
Rate for Payer: Qualcare PPO/HMO/WC	$285.00

WEDGE FIBULAR 6MM 500418

Facility

$1,900.00

Hospital Charge Code	270616214
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$459.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.80
Rate for Payer: Qualcare PPO/HMO/WC	$285.00

WEDGE GRAFT LAPIDUS 8X8X10MM

Facility

$10,312.50

Service Code	HCPCS C1713
Hospital Charge Code	270700161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,546.88
Max. Negotiated Rate	$2,495.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,495.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,546.88

WEDGE GRAFT LAPIDUS 8X8X10MM

Facility

$10,312.50

Service Code	HCPCS C1713
Hospital Charge Code	270700161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,546.88
Max. Negotiated Rate	$5,156.25
Rate for Payer: Aetna Commercial	$3,093.75
Rate for Payer: Aetna Medicare Advantage	$3,093.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,629.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,629.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,629.69
Rate for Payer: Cigna Commercial	$5,156.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,495.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,546.88

Know your out-of-pocket cost for care.

All Charges