Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DISTAL RADIUS NRW 4H LF

Facility

$4,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270664367
Hospital Revenue Code	278
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$2,337.50
Rate for Payer: Aetna Commercial	$1,402.50
Rate for Payer: Aetna Medicare Advantage	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,192.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,192.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,192.12
Rate for Payer: Cigna Commercial	$2,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,131.35
Rate for Payer: Qualcare PPO/HMO/WC	$701.25

PLATE DISTAL RADUIS, 3 HOLE

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664365
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,342.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DISTAL RADUIS, 3 HOLE

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664365
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DISTAL TIBIA MED. 6H RT

Facility

$10,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270673661
Hospital Revenue Code	278
Min. Negotiated Rate	$1,512.75
Max. Negotiated Rate	$5,042.50
Rate for Payer: Aetna Commercial	$3,025.50
Rate for Payer: Aetna Medicare Advantage	$3,025.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,571.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,571.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,017.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,571.68
Rate for Payer: Cigna Commercial	$5,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,440.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,512.75

PLATE DISTAL TIBIA MED. 6H RT

Facility

$10,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270673661
Hospital Revenue Code	278
Min. Negotiated Rate	$1,512.75
Max. Negotiated Rate	$2,440.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,017.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,440.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,512.75

PLATE DISTAL VOL/RADIUS 22x51m

Facility

$13,250.00

Hospital Charge Code	270667474
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$3,975.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

PLATE DISTAL VOL/RADIUS 22x51m

Facility

$13,250.00

Hospital Charge Code	270667474
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

PLATE DIST FEM NCB 15H LT317MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

PLATE DIST FEM NCB 15H LT317MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

PLATE DIST FIBULA 8H RT 212238

Facility

$4,995.00

Hospital Charge Code	270643373
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

PLATE DIST FIBULA 8H RT 212238

Facility

$4,995.00

Hospital Charge Code	270643373
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,498.50
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

PLATE DIST LAT FEM LT FEM 10H

Facility

$14,942.05

Service Code	HCPCS C1713
Hospital Charge Code	270693021
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.31
Max. Negotiated Rate	$7,471.02
Rate for Payer: Aetna Commercial	$4,482.61
Rate for Payer: Aetna Medicare Advantage	$4,482.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,810.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,810.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,810.22
Rate for Payer: Cigna Commercial	$7,471.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.31

PLATE DIST LAT FEM LT FEM 10H

Facility

$14,942.05

Service Code	HCPCS C1713
Hospital Charge Code	270693021
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.31
Max. Negotiated Rate	$3,615.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.31

PLATE DISTL CLAVICAL 10 HOLE L

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687601
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 DISTL CLAVICAL 10 HOLE L

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687601
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 DISTL CLAVICAL 10 HOLE R

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687602
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 DISTL CLAVICAL 10 HOLE R

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687602
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 DIST RAD VOL STD 3H RT

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664368
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DIST RAD VOL STD 3H RT

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664368
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,342.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DM TIBIA RT 10H LT 175MM

Facility

$12,751.25

Service Code	HCPCS C1713
Hospital Charge Code	270699640
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.69
Max. Negotiated Rate	$6,375.62
Rate for Payer: Aetna Commercial	$3,825.38
Rate for Payer: Aetna Medicare Advantage	$3,825.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.57
Rate for Payer: Cigna Commercial	$6,375.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.69

PLATE DM TIBIA RT 10H LT 175MM

Facility

$12,751.25

Service Code	HCPCS C1713
Hospital Charge Code	270699640
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.69
Max. Negotiated Rate	$3,085.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.69

PLATE DORSAL 2.4X51MM 5H-90

Facility

$2,373.00

Hospital Charge Code	270661609
Hospital Revenue Code	278
Min. Negotiated Rate	$355.95
Max. Negotiated Rate	$574.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.27
Rate for Payer: Qualcare PPO/HMO/WC	$355.95

PLATE DORSAL 2.4X51MM 5H-90

Facility

$2,373.00

Hospital Charge Code	270661609
Hospital Revenue Code	278
Min. Negotiated Rate	$355.95
Max. Negotiated Rate	$1,186.50
Rate for Payer: Aetna Commercial	$711.90
Rate for Payer: Aetna Medicare Advantage	$711.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.12
Rate for Payer: Cigna Commercial	$1,186.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.27
Rate for Payer: Qualcare PPO/HMO/WC	$355.95

PLATE DORS DIST RADI 3H-90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661613
Hospital Revenue Code	278
Min. Negotiated Rate	$375.90
Max. Negotiated Rate	$1,253.00
Rate for Payer: Aetna Commercial	$751.80
Rate for Payer: Aetna Medicare Advantage	$751.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$639.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$639.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$639.03
Rate for Payer: Cigna Commercial	$1,253.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: Qualcare PPO/HMO/WC	$375.90

PLATE DORS DIST RADI 3H-90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661613
Hospital Revenue Code	278
Min. Negotiated Rate	$375.90
Max. Negotiated Rate	$606.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: Qualcare PPO/HMO/WC	$375.90

Know your out-of-pocket cost for care.

All Charges