Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE ANTERIOR STR LG RT 116MM

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270672734
Hospital Revenue Code	278
Min. Negotiated Rate	$1,944.75
Max. Negotiated Rate	$3,137.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,137.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.75

PLATE ANTERIOR STR LG RT 116MM

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270672734
Hospital Revenue Code	278
Min. Negotiated Rate	$1,944.75
Max. Negotiated Rate	$6,482.50
Rate for Payer: Aetna Commercial	$3,889.50
Rate for Payer: Aetna Medicare Advantage	$3,889.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,306.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,306.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,306.07
Rate for Payer: Cigna Commercial	$6,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,137.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.75

PLATE ARCHON 36MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693540
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$1,815.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE ARCHON 36MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693540
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE ARCHON 38MM 2-LEVEL

Facility

$6,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270693343
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE ARCHON 38MM 2-LEVEL

Facility

$6,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270693343
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$1,815.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE ARCHON 40MM 2 LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270694489
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE ARCHON 40MM 2 LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270694489
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$1,815.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE ATK BUTRSS 1.75MM 905900

Facility

$1,303.25

Hospital Charge Code	270616221
Hospital Revenue Code	278
Min. Negotiated Rate	$195.49
Max. Negotiated Rate	$651.62
Rate for Payer: Aetna Commercial	$390.98
Rate for Payer: Aetna Medicare Advantage	$390.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.33
Rate for Payer: Cigna Commercial	$651.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.39
Rate for Payer: Qualcare PPO/HMO/WC	$195.49

PLATE ATK BUTRSS 1.75MM 905900

Facility

$1,303.25

Hospital Charge Code	270616221
Hospital Revenue Code	278
Min. Negotiated Rate	$195.49
Max. Negotiated Rate	$315.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.39
Rate for Payer: Qualcare PPO/HMO/WC	$195.49

PLATE BEND 4 H 87 MM RIGHT LCP

Facility

$7,162.60

Service Code	HCPCS C1713
Hospital Charge Code	270686078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,074.39
Max. Negotiated Rate	$3,581.30
Rate for Payer: Aetna Commercial	$2,148.78
Rate for Payer: Aetna Medicare Advantage	$2,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,826.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,826.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,826.46
Rate for Payer: Cigna Commercial	$3,581.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,733.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,074.39

PLATE BEND 4 H 87 MM RIGHT LCP

Facility

$7,162.60

Service Code	HCPCS C1713
Hospital Charge Code	270686078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,074.39
Max. Negotiated Rate	$1,733.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,733.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,074.39

PLATE BGA TIBIAL 12.5 AR13200

Facility

$3,793.65

Hospital Charge Code	270616688
Hospital Revenue Code	278
Min. Negotiated Rate	$569.05
Max. Negotiated Rate	$918.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$758.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$918.06
Rate for Payer: Qualcare PPO/HMO/WC	$569.05

PLATE BGA TIBIAL 12.5 AR13200

Facility

$3,793.65

Hospital Charge Code	270616688
Hospital Revenue Code	278
Min. Negotiated Rate	$569.05
Max. Negotiated Rate	$1,896.83
Rate for Payer: Aetna Commercial	$1,138.10
Rate for Payer: Aetna Medicare Advantage	$1,138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$758.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$967.38
Rate for Payer: Cigna Commercial	$1,896.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$918.06
Rate for Payer: Qualcare PPO/HMO/WC	$569.05

PLATE BMT CABLE 248 200325

Facility

$10,113.50

Hospital Charge Code	270627424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.03
Max. Negotiated Rate	$2,447.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,022.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,447.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.03

PLATE BMT CABLE 248 200325

Facility

$10,113.50

Hospital Charge Code	270627424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.03
Max. Negotiated Rate	$5,056.75
Rate for Payer: Aetna Commercial	$3,034.05
Rate for Payer: Aetna Medicare Advantage	$3,034.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,578.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,578.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,022.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,578.94
Rate for Payer: Cigna Commercial	$5,056.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,447.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.03

PLATE BMT TIBIAL 67MM 141212

Facility

$3,871.25

Hospital Charge Code	270606312
Hospital Revenue Code	278
Min. Negotiated Rate	$580.69
Max. Negotiated Rate	$1,935.62
Rate for Payer: Aetna Commercial	$1,161.38
Rate for Payer: Aetna Medicare Advantage	$1,161.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$987.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$987.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$774.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$987.17
Rate for Payer: Cigna Commercial	$1,935.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$936.84
Rate for Payer: Qualcare PPO/HMO/WC	$580.69

PLATE BMT TIBIAL 67MM 141212

Facility

$3,871.25

Hospital Charge Code	270606312
Hospital Revenue Code	278
Min. Negotiated Rate	$580.69
Max. Negotiated Rate	$936.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$774.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$936.84
Rate for Payer: Qualcare PPO/HMO/WC	$580.69

PLATE BMT TIBIAL 67MM 141222

Facility

$7,890.00

Hospital Charge Code	270629063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.50
Max. Negotiated Rate	$3,945.00
Rate for Payer: Aetna Commercial	$2,367.00
Rate for Payer: Aetna Medicare Advantage	$2,367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,578.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,011.95
Rate for Payer: Cigna Commercial	$3,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,909.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.50

PLATE BMT TIBIAL 67MM 141222

Facility

$7,890.00

Hospital Charge Code	270629063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.50
Max. Negotiated Rate	$1,909.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,909.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.50

PLATE BMT TIBIAL 71MM 141213

Facility

$3,871.25

Hospital Charge Code	270609003
Hospital Revenue Code	278
Min. Negotiated Rate	$580.69
Max. Negotiated Rate	$1,935.62
Rate for Payer: Aetna Commercial	$1,161.38
Rate for Payer: Aetna Medicare Advantage	$1,161.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$987.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$987.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$774.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$987.17
Rate for Payer: Cigna Commercial	$1,935.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$936.84
Rate for Payer: Qualcare PPO/HMO/WC	$580.69

PLATE BMT TIBIAL 71MM 141213

Facility

$3,871.25

Hospital Charge Code	270609003
Hospital Revenue Code	278
Min. Negotiated Rate	$580.69
Max. Negotiated Rate	$936.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$774.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$936.84
Rate for Payer: Qualcare PPO/HMO/WC	$580.69

PLATE BMT TIBIAL 71MM 141223

Facility

$7,826.95

Hospital Charge Code	270617362
Hospital Revenue Code	278
Min. Negotiated Rate	$1,174.04
Max. Negotiated Rate	$1,894.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,565.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,894.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,174.04

PLATE BMT TIBIAL 71MM 141223

Facility

$7,826.95

Hospital Charge Code	270617362
Hospital Revenue Code	278
Min. Negotiated Rate	$1,174.04
Max. Negotiated Rate	$3,913.47
Rate for Payer: Aetna Commercial	$2,348.09
Rate for Payer: Aetna Medicare Advantage	$2,348.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,995.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,995.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,565.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,995.87
Rate for Payer: Cigna Commercial	$3,913.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,894.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,174.04

Know your out-of-pocket cost for care.

All Charges