Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATEFIBULALATLKG8H132MMRT

Facility

$4,355.00

Service Code	HCPCS C1713
Hospital Charge Code	270695536
Hospital Revenue Code	278
Min. Negotiated Rate	$653.25
Max. Negotiated Rate	$1,053.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$871.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,053.91
Rate for Payer: Qualcare PPO/HMO/WC	$653.25

PLATE FIBULA LCP DISTAL RIGHT

Facility

$5,810.00

Hospital Charge Code	270666965
Hospital Revenue Code	278
Min. Negotiated Rate	$871.50
Max. Negotiated Rate	$2,905.00
Rate for Payer: Aetna Commercial	$1,743.00
Rate for Payer: Aetna Medicare Advantage	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,481.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,481.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,481.55
Rate for Payer: Cigna Commercial	$2,905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,406.02
Rate for Payer: Qualcare PPO/HMO/WC	$871.50

PLATE FIBULA LCP DISTAL RIGHT

Facility

$5,810.00

Hospital Charge Code	270666965
Hospital Revenue Code	278
Min. Negotiated Rate	$871.50
Max. Negotiated Rate	$1,406.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,406.02
Rate for Payer: Qualcare PPO/HMO/WC	$871.50

PLATE FIBULA LOCKING 4 HOLE

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691059
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

PLATE FIBULA LOCKING 4 HOLE

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691059
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

PLATE FIBULAR 5 HOLE

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691919
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE FIBULAR 5 HOLE

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691919
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE FIBULAR STR 9-HOLE

Facility

$3,437.50

Service Code	HCPCS C1713
Hospital Charge Code	270701514
Hospital Revenue Code	278
Min. Negotiated Rate	$515.62
Max. Negotiated Rate	$831.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$831.88
Rate for Payer: Qualcare PPO/HMO/WC	$515.62

PLATE FIBULAR STR 9-HOLE

Facility

$3,437.50

Service Code	HCPCS C1713
Hospital Charge Code	270701514
Hospital Revenue Code	278
Min. Negotiated Rate	$515.62
Max. Negotiated Rate	$1,718.75
Rate for Payer: Aetna Commercial	$1,031.25
Rate for Payer: Aetna Medicare Advantage	$1,031.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$876.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$876.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$876.56
Rate for Payer: Cigna Commercial	$1,718.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$831.88
Rate for Payer: Qualcare PPO/HMO/WC	$515.62

PLATE FIBULA STR 10 HOLES

Facility

$3,500.00

Hospital Charge Code	270669980
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE FIBULA STR 10 HOLES

Facility

$3,500.00

Hospital Charge Code	270669980
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

PLATE FIBULA STR 8 HOLES 108MM

Facility

$3,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270665783
Hospital Revenue Code	278
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$755.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.04
Rate for Payer: Qualcare PPO/HMO/WC	$468.00

PLATE FIBULA STR 8 HOLES 108MM

Facility

$3,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270665783
Hospital Revenue Code	278
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$1,560.00
Rate for Payer: Aetna Commercial	$936.00
Rate for Payer: Aetna Medicare Advantage	$936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$795.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$795.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$795.60
Rate for Payer: Cigna Commercial	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.04
Rate for Payer: Qualcare PPO/HMO/WC	$468.00

PLATE FIBULA STRAIGHT 4H 60MM

Facility

$2,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270674889
Hospital Revenue Code	278
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Aetna Commercial	$726.00
Rate for Payer: Aetna Medicare Advantage	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.10
Rate for Payer: Cigna Commercial	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.64
Rate for Payer: Qualcare PPO/HMO/WC	$363.00

PLATE FIBULA STRAIGHT 4H 60MM

Facility

$2,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270674889
Hospital Revenue Code	278
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$585.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$484.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.64
Rate for Payer: Qualcare PPO/HMO/WC	$363.00

PLATE FIBULA TI 11H CLUSTER RT

Facility

$6,861.25

Service Code	HCPCS C1713
Hospital Charge Code	270700402
Hospital Revenue Code	278
Min. Negotiated Rate	$1,029.19
Max. Negotiated Rate	$1,660.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,372.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,029.19

PLATE FIBULA TI 11H CLUSTER RT

Facility

$6,861.25

Service Code	HCPCS C1713
Hospital Charge Code	270700402
Hospital Revenue Code	278
Min. Negotiated Rate	$1,029.19
Max. Negotiated Rate	$3,430.62
Rate for Payer: Aetna Commercial	$2,058.38
Rate for Payer: Aetna Medicare Advantage	$2,058.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,372.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.62
Rate for Payer: Cigna Commercial	$3,430.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,029.19

PLATE FIBULA VA-LCP 2.7MM LT3H

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270695311
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

PLATE FIBULA VA-LCP 2.7MM LT3H

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270695311
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

PLATE FIRST TMT FUSION 2.4/ 2.

Facility

$4,541.75

Service Code	HCPCS C1713
Hospital Charge Code	270681819
Hospital Revenue Code	278
Min. Negotiated Rate	$681.26
Max. Negotiated Rate	$2,270.88
Rate for Payer: Aetna Commercial	$1,362.53
Rate for Payer: Aetna Medicare Advantage	$1,362.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,158.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,158.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$908.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,158.15
Rate for Payer: Cigna Commercial	$2,270.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,099.10
Rate for Payer: Qualcare PPO/HMO/WC	$681.26

PLATE FIRST TMT FUSION 2.4/ 2.

Facility

$4,541.75

Service Code	HCPCS C1713
Hospital Charge Code	270681819
Hospital Revenue Code	278
Min. Negotiated Rate	$681.26
Max. Negotiated Rate	$1,099.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$908.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,099.10
Rate for Payer: Qualcare PPO/HMO/WC	$681.26

PLATE FOREFOOT UNIVERSAL 18MM

Facility

$6,279.10

Hospital Charge Code	270657193
Hospital Revenue Code	278
Min. Negotiated Rate	$941.87
Max. Negotiated Rate	$3,139.55
Rate for Payer: Aetna Commercial	$1,883.73
Rate for Payer: Aetna Medicare Advantage	$1,883.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,255.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.17
Rate for Payer: Cigna Commercial	$3,139.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.54
Rate for Payer: Qualcare PPO/HMO/WC	$941.87

PLATE FOREFOOT UNIVERSAL 18MM

Facility

$6,279.10

Hospital Charge Code	270657193
Hospital Revenue Code	278
Min. Negotiated Rate	$941.87
Max. Negotiated Rate	$1,519.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,255.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.54
Rate for Payer: Qualcare PPO/HMO/WC	$941.87

PLATE,FRAGMENT DISTAL ULNA

Facility

$4,475.00

Hospital Charge Code	270668300
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,FRAGMENT DISTAL ULNA

Facility

$4,475.00

Hospital Charge Code	270668300
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

Know your out-of-pocket cost for care.

All Charges