Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 3 HOL R PROX HUME 437123

Facility

$6,900.00

Hospital Charge Code	270640119
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$3,450.00
Rate for Payer: Aetna Commercial	$2,070.00
Rate for Payer: Aetna Medicare Advantage	$2,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,759.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,759.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,759.50
Rate for Payer: Cigna Commercial	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,669.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.00

PLATE 3 LEVEL 45MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE 3 LEVEL 45MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$5,775.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE 3MM WEDGE

Facility

$7,537.50

Service Code	HCPCS C1713
Hospital Charge Code	270679461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.62
Max. Negotiated Rate	$3,768.75
Rate for Payer: Aetna Commercial	$2,261.25
Rate for Payer: Aetna Medicare Advantage	$2,261.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,507.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,922.06
Rate for Payer: Cigna Commercial	$3,768.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,824.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.62

PLATE 3MM WEDGE

Facility

$7,537.50

Service Code	HCPCS C1713
Hospital Charge Code	270679461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.62
Max. Negotiated Rate	$1,824.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,824.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.62

PLATE 4.0 MM X 14 MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692990
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

PLATE 4.0 MM X 14 MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692990
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

PLATE 41 MM X 2 LEVEL FUS

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692107
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

PLATE 41 MM X 2 LEVEL FUS

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692107
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$4,125.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

PLATE 42MM

Facility

$5,237.45

Service Code	HCPCS C1713
Hospital Charge Code	270703881
Hospital Revenue Code	278
Min. Negotiated Rate	$785.62
Max. Negotiated Rate	$2,618.72
Rate for Payer: Aetna Commercial	$1,571.23
Rate for Payer: Aetna Medicare Advantage	$1,571.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,335.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,335.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,047.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,335.55
Rate for Payer: Cigna Commercial	$2,618.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.46
Rate for Payer: Qualcare PPO/HMO/WC	$785.62

PLATE 42MM

Facility

$5,237.45

Service Code	HCPCS C1713
Hospital Charge Code	270703881
Hospital Revenue Code	278
Min. Negotiated Rate	$785.62
Max. Negotiated Rate	$1,267.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,047.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.46
Rate for Payer: Qualcare PPO/HMO/WC	$785.62

PLATE 42MM 2LVL

Facility

$5,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693716
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

PLATE 42MM 2LVL

Facility

$5,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693716
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

PLATE 44MM

Facility

$2,000.00

Hospital Charge Code	270703128
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PLATE 44MM

Facility

$2,000.00

Hospital Charge Code	270703128
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PLATE 4.5mm ACT 8-H 146688000

Facility

$639.90

Hospital Charge Code	270633296
Hospital Revenue Code	278
Min. Negotiated Rate	$95.98
Max. Negotiated Rate	$319.95
Rate for Payer: Aetna Commercial	$191.97
Rate for Payer: Aetna Medicare Advantage	$191.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.17
Rate for Payer: Cigna Commercial	$319.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.86
Rate for Payer: Qualcare PPO/HMO/WC	$95.98

PLATE 4.5mm ACT 8-H 146688000

Facility

$639.90

Hospital Charge Code	270633296
Hospital Revenue Code	278
Min. Negotiated Rate	$95.98
Max. Negotiated Rate	$154.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.86
Rate for Payer: Qualcare PPO/HMO/WC	$95.98

PLATE 4.5mm CONDYLAR 12HOLE LT

Facility

$7,048.30

Service Code	HCPCS C1713
Hospital Charge Code	270641542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.24
Max. Negotiated Rate	$3,524.15
Rate for Payer: Aetna Commercial	$2,114.49
Rate for Payer: Aetna Medicare Advantage	$2,114.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.32
Rate for Payer: Cigna Commercial	$3,524.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,705.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.24

PLATE 4.5mm CONDYLAR 12HOLE LT

Facility

$7,048.30

Service Code	HCPCS C1713
Hospital Charge Code	270641542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.24
Max. Negotiated Rate	$1,705.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,705.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.24

PLATE 4.5MM NARROW LC-DCP

Facility

$816.00

Hospital Charge Code	270656208
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$244.80
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

PLATE 4.5MM NARROW LC-DCP

Facility

$816.00

Hospital Charge Code	270656208
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

PLATE 4.5 VA LCP 14H 301MM RT

Facility

$29,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270699395
Hospital Revenue Code	278
Min. Negotiated Rate	$4,437.75
Max. Negotiated Rate	$14,792.50
Rate for Payer: Aetna Commercial	$8,875.50
Rate for Payer: Aetna Medicare Advantage	$8,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,544.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,544.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,917.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,544.18
Rate for Payer: Cigna Commercial	$14,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,159.57
Rate for Payer: Qualcare PPO/HMO/WC	$4,437.75

PLATE 4.5 VA LCP 14H 301MM RT

Facility

$29,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270699395
Hospital Revenue Code	278
Min. Negotiated Rate	$4,437.75
Max. Negotiated Rate	$7,159.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,917.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,159.57
Rate for Payer: Qualcare PPO/HMO/WC	$4,437.75

PLATE 46 MM 2 LEVEL

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270691971
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE 46 MM 2 LEVEL

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270691971
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$1,956.00
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

Know your out-of-pocket cost for care.

All Charges