Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 34MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705062
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE 34MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705062
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE 34MM 2 HOLE

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.28
Max. Negotiated Rate	$3,954.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28

PLATE 34MM 2 HOLE

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.28
Max. Negotiated Rate	$8,170.95
Rate for Payer: Aetna Commercial	$4,902.57
Rate for Payer: Aetna Medicare Advantage	$4,902.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,167.18
Rate for Payer: Cigna Commercial	$8,170.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28

PLATE 3.5 CLOUM FUSION RIGHT

Facility

$8,882.95

Service Code	HCPCS C1713
Hospital Charge Code	270690795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,332.44
Max. Negotiated Rate	$2,149.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,776.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,149.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,332.44

PLATE 3.5 CLOUM FUSION RIGHT

Facility

$8,882.95

Service Code	HCPCS C1713
Hospital Charge Code	270690795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,332.44
Max. Negotiated Rate	$4,441.48
Rate for Payer: Aetna Commercial	$2,664.89
Rate for Payer: Aetna Medicare Advantage	$2,664.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,265.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,265.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,776.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,265.15
Rate for Payer: Cigna Commercial	$4,441.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,149.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,332.44

PLATE 3.5 LCP PROX HUM 6H163MM

Facility

$28,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270699354
Hospital Revenue Code	278
Min. Negotiated Rate	$4,206.75
Max. Negotiated Rate	$6,786.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,609.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,786.89
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.75

PLATE 3.5 LCP PROX HUM 6H163MM

Facility

$28,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270699354
Hospital Revenue Code	278
Min. Negotiated Rate	$4,206.75
Max. Negotiated Rate	$14,022.50
Rate for Payer: Aetna Commercial	$8,413.50
Rate for Payer: Aetna Medicare Advantage	$8,413.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,151.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,151.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,609.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,151.48
Rate for Payer: Cigna Commercial	$14,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,786.89
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.75

PLATE 3.5 LCP PROX HUM 8H RT

Facility

$11,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270696393
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$2,758.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

PLATE 3.5 LCP PROX HUM 8H RT

Facility

$11,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270696393
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$5,700.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$3,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,907.00
Rate for Payer: Cigna Commercial	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

PLATE3.5MM LC-DCP10HOLES/129MM

Facility

$741.60

Service Code	HCPCS C1713
Hospital Charge Code	270655654
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna Commercial	$222.48
Rate for Payer: Aetna Medicare Advantage	$222.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.11
Rate for Payer: Cigna Commercial	$370.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.47
Rate for Payer: Qualcare PPO/HMO/WC	$111.24

PLATE3.5MM LC-DCP10HOLES/129MM

Facility

$741.60

Service Code	HCPCS C1713
Hospital Charge Code	270655654
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$179.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.47
Rate for Payer: Qualcare PPO/HMO/WC	$111.24

PLATE3.5MM LC-DCP 9HOLES/116MM

Facility

$732.35

Service Code	HCPCS C1713
Hospital Charge Code	270655652
Hospital Revenue Code	278
Min. Negotiated Rate	$109.85
Max. Negotiated Rate	$177.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.23
Rate for Payer: Qualcare PPO/HMO/WC	$109.85

PLATE3.5MM LC-DCP 9HOLES/116MM

Facility

$732.35

Service Code	HCPCS C1713
Hospital Charge Code	270655652
Hospital Revenue Code	278
Min. Negotiated Rate	$109.85
Max. Negotiated Rate	$366.18
Rate for Payer: Aetna Commercial	$219.71
Rate for Payer: Aetna Medicare Advantage	$219.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.75
Rate for Payer: Cigna Commercial	$366.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.23
Rate for Payer: Qualcare PPO/HMO/WC	$109.85

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,498.00

Hospital Charge Code	270656205
Hospital Revenue Code	278
Min. Negotiated Rate	$974.70
Max. Negotiated Rate	$1,572.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,572.52
Rate for Payer: Qualcare PPO/HMO/WC	$974.70

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,498.00

Hospital Charge Code	270656205
Hospital Revenue Code	278
Min. Negotiated Rate	$974.70
Max. Negotiated Rate	$3,249.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,949.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.99
Rate for Payer: Cigna Commercial	$3,249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,572.52
Rate for Payer: Qualcare PPO/HMO/WC	$974.70

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,702.00

Hospital Charge Code	270656206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.30
Max. Negotiated Rate	$3,351.00
Rate for Payer: Aetna Commercial	$2,010.60
Rate for Payer: Aetna Medicare Advantage	$2,010.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.01
Rate for Payer: Cigna Commercial	$3,351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.30

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,702.00

Hospital Charge Code	270656206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.30
Max. Negotiated Rate	$1,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.30

PLATE3.5MMLCPPROXTIB8HR145MM

Facility

$8,399.40

Service Code	HCPCS C1713
Hospital Charge Code	270696100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,259.91
Max. Negotiated Rate	$4,199.70
Rate for Payer: Aetna Commercial	$2,519.82
Rate for Payer: Aetna Medicare Advantage	$2,519.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,679.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,141.85
Rate for Payer: Cigna Commercial	$4,199.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.91

PLATE3.5MMLCPPROXTIB8HR145MM

Facility

$8,399.40

Service Code	HCPCS C1713
Hospital Charge Code	270696100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,259.91
Max. Negotiated Rate	$2,032.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,679.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.91

PLATE 3.5mm LOCK 5-HOL 2110409

Facility

$4,495.00

Hospital Charge Code	270643386
Hospital Revenue Code	278
Min. Negotiated Rate	$674.25
Max. Negotiated Rate	$2,247.50
Rate for Payer: Aetna Commercial	$1,348.50
Rate for Payer: Aetna Medicare Advantage	$1,348.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,146.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,146.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$899.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,146.22
Rate for Payer: Cigna Commercial	$2,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.79
Rate for Payer: Qualcare PPO/HMO/WC	$674.25

PLATE 3.5mm LOCK 5-HOL 2110409

Facility

$4,495.00

Hospital Charge Code	270643386
Hospital Revenue Code	278
Min. Negotiated Rate	$674.25
Max. Negotiated Rate	$1,087.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$899.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.79
Rate for Payer: Qualcare PPO/HMO/WC	$674.25

PLATE 3.5 MM POW LOCK

Facility

$6,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270684000
Hospital Revenue Code	278
Min. Negotiated Rate	$959.25
Max. Negotiated Rate	$3,197.50
Rate for Payer: Aetna Commercial	$1,918.50
Rate for Payer: Aetna Medicare Advantage	$1,918.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,630.72
Rate for Payer: Cigna Commercial	$3,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,547.59
Rate for Payer: Qualcare PPO/HMO/WC	$959.25

PLATE 3.5 MM POW LOCK

Facility

$6,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270684000
Hospital Revenue Code	278
Min. Negotiated Rate	$959.25
Max. Negotiated Rate	$1,547.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,547.59
Rate for Payer: Qualcare PPO/HMO/WC	$959.25

PLATE 3.5MM RECON 6HOLE/70MM

Facility

$1,928.15

Service Code	HCPCS C1713
Hospital Charge Code	270603390
Hospital Revenue Code	278
Min. Negotiated Rate	$289.22
Max. Negotiated Rate	$964.08
Rate for Payer: Aetna Commercial	$578.45
Rate for Payer: Aetna Medicare Advantage	$578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$491.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$491.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$491.68
Rate for Payer: Cigna Commercial	$964.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$466.61
Rate for Payer: Qualcare PPO/HMO/WC	$289.22

Know your out-of-pocket cost for care.

All Charges