Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ANT CERV 4LEVEL 68MM

Facility

$15,553.00

Service Code	HCPCS C1776
Hospital Charge Code	270694821
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.95
Max. Negotiated Rate	$3,763.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.95

PLATE ANT CERV 4LEVEL 68MM

Facility

$15,553.00

Service Code	HCPCS C1776
Hospital Charge Code	270694821
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.95
Max. Negotiated Rate	$7,776.50
Rate for Payer: Aetna Commercial	$4,665.90
Rate for Payer: Aetna Medicare Advantage	$4,665.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,966.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,966.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,966.01
Rate for Payer: Cigna Commercial	$7,776.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.95

PLATE ANT CERV 7MM 2H

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694350
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANT CERV 7MM 2H

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694350
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANT CERV 8MM 2H

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694351
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANT CERV 8MM 2H

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694351
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANT CERV ATLANTIS 65 MM

Facility

$12,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270691795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.75
Max. Negotiated Rate	$3,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,055.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.75

PLATE ANT CERV ATLANTIS 65 MM

Facility

$12,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270691795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.75
Max. Negotiated Rate	$6,312.50
Rate for Payer: Aetna Commercial	$3,787.50
Rate for Payer: Aetna Medicare Advantage	$3,787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,219.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,219.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,219.38
Rate for Payer: Cigna Commercial	$6,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,055.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.75

PLATE ANT CERV GRUVE 2LEV 36MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699026
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE ANT CERV GRUVE 2LEV 36MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699026
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE ANT CERV GRUVE 55

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270699338
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,440.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE ANT CERV GRUVE 55

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270699338
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE ANT CERVICAL 2 LEV 32MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697344
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 ANT CERVICAL 2 LEV 32MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697344
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 ANT CERVICAL 2LEVEL 24MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696964
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 ANT CERVICAL 2LEVEL 24MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696964
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 ANT CERV SKYLINE 26 MM

Facility

$6,757.50

Service Code	HCPCS C1713
Hospital Charge Code	270691716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.62
Max. Negotiated Rate	$1,635.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,351.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,635.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.62

PLATE ANT CERV SKYLINE 26 MM

Facility

$6,757.50

Service Code	HCPCS C1713
Hospital Charge Code	270691716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.62
Max. Negotiated Rate	$3,378.75
Rate for Payer: Aetna Commercial	$2,027.25
Rate for Payer: Aetna Medicare Advantage	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,723.16
Rate for Payer: Cigna Commercial	$3,378.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,635.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.62

PLATE ANT CERV UNI 1LEV 20MM

Facility

$5,035.00

Service Code	HCPCS C1713
Hospital Charge Code	270689762
Hospital Revenue Code	278
Min. Negotiated Rate	$755.25
Max. Negotiated Rate	$1,218.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,007.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.47
Rate for Payer: Qualcare PPO/HMO/WC	$755.25

PLATE ANT CERV UNI 1LEV 20MM

Facility

$5,035.00

Service Code	HCPCS C1713
Hospital Charge Code	270689762
Hospital Revenue Code	278
Min. Negotiated Rate	$755.25
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,510.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,283.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,283.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,007.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,283.92
Rate for Payer: Cigna Commercial	$2,517.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.47
Rate for Payer: Qualcare PPO/HMO/WC	$755.25

PLATE ANTERIOR 2H 6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694365
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANTERIOR 2H 6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694365
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANTERIOR LARGE

Facility

$11,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270687138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.00
Max. Negotiated Rate	$2,666.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,666.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.00

PLATE ANTERIOR LARGE

Facility

$11,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270687138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.00
Max. Negotiated Rate	$5,510.00
Rate for Payer: Aetna Commercial	$3,306.00
Rate for Payer: Aetna Medicare Advantage	$3,306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,810.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,810.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,810.10
Rate for Payer: Cigna Commercial	$5,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,666.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.00

PLATE ANTERIOR RT LAT SMALL

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270685125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$2,835.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

Know your out-of-pocket cost for care.

All Charges