Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 1/3 TUB 6 HOLES/73MM

Facility

$307.45

Service Code	HCPCS C1713
Hospital Charge Code	270655682
Hospital Revenue Code	278
Min. Negotiated Rate	$46.12
Max. Negotiated Rate	$153.72
Rate for Payer: Aetna Commercial	$92.23
Rate for Payer: Aetna Medicare Advantage	$92.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.40
Rate for Payer: Cigna Commercial	$153.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$46.12

PLATE 1/3 TUBULAR 10HOLE 121MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270603385
Hospital Revenue Code	278
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$156.05
Rate for Payer: Aetna Commercial	$93.63
Rate for Payer: Aetna Medicare Advantage	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.59
Rate for Payer: Cigna Commercial	$156.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.53
Rate for Payer: Qualcare PPO/HMO/WC	$46.81

PLATE 1/3 TUBULAR 10HOLE 121MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270603385
Hospital Revenue Code	278
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$75.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.53
Rate for Payer: Qualcare PPO/HMO/WC	$46.81

PLATE 1/3 TUBULAR 12H 145MM

Facility

$327.55

Service Code	HCPCS C1713
Hospital Charge Code	270604308
Hospital Revenue Code	278
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$79.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.27
Rate for Payer: Qualcare PPO/HMO/WC	$49.13

PLATE 1/3 TUBULAR 12H 145MM

Facility

$327.55

Service Code	HCPCS C1713
Hospital Charge Code	270604308
Hospital Revenue Code	278
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$163.78
Rate for Payer: Aetna Commercial	$98.27
Rate for Payer: Aetna Medicare Advantage	$98.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.53
Rate for Payer: Cigna Commercial	$163.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.27
Rate for Payer: Qualcare PPO/HMO/WC	$49.13

PLATE 1/3 TUBULAR 2HOLE 25MM

Facility

$237.95

Service Code	HCPCS C1713
Hospital Charge Code	270603362
Hospital Revenue Code	278
Min. Negotiated Rate	$35.69
Max. Negotiated Rate	$57.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.58
Rate for Payer: Qualcare PPO/HMO/WC	$35.69

PLATE 1/3 TUBULAR 2HOLE 25MM

Facility

$237.95

Service Code	HCPCS C1713
Hospital Charge Code	270603362
Hospital Revenue Code	278
Min. Negotiated Rate	$35.69
Max. Negotiated Rate	$118.97
Rate for Payer: Aetna Commercial	$71.39
Rate for Payer: Aetna Medicare Advantage	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.68
Rate for Payer: Cigna Commercial	$118.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.58
Rate for Payer: Qualcare PPO/HMO/WC	$35.69

PLATE 1/3 TUBULAR 3HOLE 37MM

Facility

$244.10

Service Code	HCPCS C1713
Hospital Charge Code	270603363
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$59.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.07
Rate for Payer: Qualcare PPO/HMO/WC	$36.62

PLATE 1/3 TUBULAR 3HOLE 37MM

Facility

$244.10

Service Code	HCPCS C1713
Hospital Charge Code	270603363
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$122.05
Rate for Payer: Aetna Commercial	$73.23
Rate for Payer: Aetna Medicare Advantage	$73.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.25
Rate for Payer: Cigna Commercial	$122.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.07
Rate for Payer: Qualcare PPO/HMO/WC	$36.62

PLATE 1/3 TUBULAR 4HOLE 49MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601907
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$86.89
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

PLATE 1/3 TUBULAR 4HOLE 49MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601907
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$70.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

PLATE 1/3 TUBULAR 5H 61MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601908
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$86.89
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

PLATE 1/3 TUBULAR 5H 61MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601908
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$70.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

PLATE-1/3 TUBULAR 6 HOLE

Facility

$445.00

Hospital Charge Code	270656542
Hospital Revenue Code	278
Min. Negotiated Rate	$66.75
Max. Negotiated Rate	$222.50
Rate for Payer: Aetna Commercial	$133.50
Rate for Payer: Aetna Medicare Advantage	$133.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.47
Rate for Payer: Cigna Commercial	$222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.69
Rate for Payer: Qualcare PPO/HMO/WC	$66.75

PLATE-1/3 TUBULAR 6 HOLE

Facility

$445.00

Hospital Charge Code	270656542
Hospital Revenue Code	278
Min. Negotiated Rate	$66.75
Max. Negotiated Rate	$107.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.69
Rate for Payer: Qualcare PPO/HMO/WC	$66.75

PLATE 1/3 TUBULAR 6HOLE 73MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	270603381
Hospital Revenue Code	278
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$70.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.66
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

PLATE 1/3 TUBULAR 6HOLE 73MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	270603381
Hospital Revenue Code	278
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$87.60
Rate for Payer: Aetna Medicare Advantage	$87.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.46
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.66
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

PLATE 1/3 TUBULAR 7H 85MM

Facility

$300.75

Service Code	HCPCS C1713
Hospital Charge Code	270601911
Hospital Revenue Code	278
Min. Negotiated Rate	$45.11
Max. Negotiated Rate	$72.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.78
Rate for Payer: Qualcare PPO/HMO/WC	$45.11

PLATE 1/3 TUBULAR 7H 85MM

Facility

$300.75

Service Code	HCPCS C1713
Hospital Charge Code	270601911
Hospital Revenue Code	278
Min. Negotiated Rate	$45.11
Max. Negotiated Rate	$150.38
Rate for Payer: Aetna Commercial	$90.22
Rate for Payer: Aetna Medicare Advantage	$90.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.69
Rate for Payer: Cigna Commercial	$150.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.78
Rate for Payer: Qualcare PPO/HMO/WC	$45.11

PLATE 1/3 TUBULAR 8 X 97MM

Facility

$302.80

Service Code	HCPCS C1713
Hospital Charge Code	270603383
Hospital Revenue Code	278
Min. Negotiated Rate	$45.42
Max. Negotiated Rate	$151.40
Rate for Payer: Aetna Commercial	$90.84
Rate for Payer: Aetna Medicare Advantage	$90.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.21
Rate for Payer: Cigna Commercial	$151.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.28
Rate for Payer: Qualcare PPO/HMO/WC	$45.42

PLATE 1/3 TUBULAR 8 X 97MM

Facility

$302.80

Service Code	HCPCS C1713
Hospital Charge Code	270603383
Hospital Revenue Code	278
Min. Negotiated Rate	$45.42
Max. Negotiated Rate	$73.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.28
Rate for Payer: Qualcare PPO/HMO/WC	$45.42

PLATE 1/3 TUBULAR 9H 109MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270651852
Hospital Revenue Code	278
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$156.05
Rate for Payer: Aetna Commercial	$93.63
Rate for Payer: Aetna Medicare Advantage	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.59
Rate for Payer: Cigna Commercial	$156.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.53
Rate for Payer: Qualcare PPO/HMO/WC	$46.81

PLATE 1/3 TUBULAR 9H 109MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270651852
Hospital Revenue Code	278
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$75.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.53
Rate for Payer: Qualcare PPO/HMO/WC	$46.81

PLATE 14HOLE CONDYLAR LEFT

Facility

$7,477.80

Service Code	HCPCS C1713
Hospital Charge Code	270656609
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.67
Max. Negotiated Rate	$3,738.90
Rate for Payer: Aetna Commercial	$2,243.34
Rate for Payer: Aetna Medicare Advantage	$2,243.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.84
Rate for Payer: Cigna Commercial	$3,738.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,809.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.67

PLATE 14HOLE CONDYLAR LEFT

Facility

$7,477.80

Service Code	HCPCS C1713
Hospital Charge Code	270656609
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.67
Max. Negotiated Rate	$1,809.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,809.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.67

Know your out-of-pocket cost for care.

All Charges