Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE LCP X-ART 8H 3.5MM LT ST

Facility

$6,510.65

Service Code	HCPCS C1713
Hospital Charge Code	270675067
Hospital Revenue Code	278
Min. Negotiated Rate	$976.60
Max. Negotiated Rate	$1,575.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,302.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,575.58
Rate for Payer: Qualcare PPO/HMO/WC	$976.60

PLATE LDF LCK 7-HLE LFT7282-10

Facility

$4,235.00

Hospital Charge Code	270647945
Hospital Revenue Code	278
Min. Negotiated Rate	$635.25
Max. Negotiated Rate	$2,117.50
Rate for Payer: Aetna Commercial	$1,270.50
Rate for Payer: Aetna Medicare Advantage	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.92
Rate for Payer: Cigna Commercial	$2,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.87
Rate for Payer: Qualcare PPO/HMO/WC	$635.25

PLATE LDF LCK 7-HLE LFT7282-10

Facility

$4,235.00

Hospital Charge Code	270647945
Hospital Revenue Code	278
Min. Negotiated Rate	$635.25
Max. Negotiated Rate	$1,024.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.87
Rate for Payer: Qualcare PPO/HMO/WC	$635.25

PLATE LEFT FIBULAR 11 HOLE CLU

Facility

$6,861.25

Service Code	HCPCS C1713
Hospital Charge Code	270701204
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 LEFT FIBULAR 11 HOLE CLU

Facility

$6,861.25

Service Code	HCPCS C1713
Hospital Charge Code	270701204
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 LEFT STANDARD LONG VD

Facility

$5,920.00

Hospital Charge Code	270665498
Hospital Revenue Code	278
Min. Negotiated Rate	$888.00
Max. Negotiated Rate	$1,432.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.64
Rate for Payer: Qualcare PPO/HMO/WC	$888.00

PLATE LEFT STANDARD LONG VD

Facility

$5,920.00

Hospital Charge Code	270665498
Hospital Revenue Code	278
Min. Negotiated Rate	$888.00
Max. Negotiated Rate	$2,960.00
Rate for Payer: Aetna Commercial	$1,776.00
Rate for Payer: Aetna Medicare Advantage	$1,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,509.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,509.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,509.60
Rate for Payer: Cigna Commercial	$2,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.64
Rate for Payer: Qualcare PPO/HMO/WC	$888.00

PLATE LEFT SUPPER 5 HOLE SUPER

Facility

$4,746.60

Service Code	HCPCS C1713
Hospital Charge Code	270690572
Hospital Revenue Code	278
Min. Negotiated Rate	$711.99
Max. Negotiated Rate	$2,373.30
Rate for Payer: Aetna Commercial	$1,423.98
Rate for Payer: Aetna Medicare Advantage	$1,423.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$949.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,210.38
Rate for Payer: Cigna Commercial	$2,373.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,148.68
Rate for Payer: Qualcare PPO/HMO/WC	$711.99

PLATE LEFT SUPPER 5 HOLE SUPER

Facility

$4,746.60

Service Code	HCPCS C1713
Hospital Charge Code	270690572
Hospital Revenue Code	278
Min. Negotiated Rate	$711.99
Max. Negotiated Rate	$1,148.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$949.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,148.68
Rate for Payer: Qualcare PPO/HMO/WC	$711.99

PLATE LEFT T-SHAPED 5-HOLE

Facility

$6,337.45

Hospital Charge Code	270657183
Hospital Revenue Code	278
Min. Negotiated Rate	$950.62
Max. Negotiated Rate	$3,168.72
Rate for Payer: Aetna Commercial	$1,901.23
Rate for Payer: Aetna Medicare Advantage	$1,901.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,616.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,616.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,267.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,616.05
Rate for Payer: Cigna Commercial	$3,168.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.66
Rate for Payer: Qualcare PPO/HMO/WC	$950.62

PLATE LEFT T-SHAPED 5-HOLE

Facility

$6,337.45

Hospital Charge Code	270657183
Hospital Revenue Code	278
Min. Negotiated Rate	$950.62
Max. Negotiated Rate	$1,533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,267.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.66
Rate for Payer: Qualcare PPO/HMO/WC	$950.62

PLATE LEFT VOLAR NARROW DISTAL

Facility

$4,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270647778
Hospital Revenue Code	278
Min. Negotiated Rate	$702.00
Max. Negotiated Rate	$1,132.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,132.56
Rate for Payer: Qualcare PPO/HMO/WC	$702.00

PLATE LEFT VOLAR NARROW DISTAL

Facility

$4,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270647778
Hospital Revenue Code	278
Min. Negotiated Rate	$702.00
Max. Negotiated Rate	$2,340.00
Rate for Payer: Aetna Commercial	$1,404.00
Rate for Payer: Aetna Medicare Advantage	$1,404.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,193.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,193.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,193.40
Rate for Payer: Cigna Commercial	$2,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,132.56
Rate for Payer: Qualcare PPO/HMO/WC	$702.00

PLATELET AB,HEPARIN IND

Facility

$390.00

Service Code	HCPCS 86022
Hospital Charge Code	39900189
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLATELET AB,HEPARIN IND

Facility

$390.00

Service Code	HCPCS 86022
Hospital Charge Code	39900189
Hospital Revenue Code	302
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.52
Rate for Payer: Aetna Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.31
Rate for Payer: Cigna Commercial	$18.37
Rate for Payer: Cigna Medicare Advantage	$9.19
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.47
Rate for Payer: Wellcare Medicare Advantage	$18.37

PLATELET AB (IGG),DIRECT

Facility

$390.00

Service Code	HCPCS 86023
Hospital Charge Code	39900190
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLATELET AB (IGG),DIRECT

Facility

$390.00

Service Code	HCPCS 86023
Hospital Charge Code	39900190
Hospital Revenue Code	302
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.37
Rate for Payer: Aetna Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$12.46
Rate for Payer: Cigna Medicare Advantage	$6.23
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.46
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.21
Rate for Payer: Wellcare Medicare Advantage	$12.46

PLATELET AB PROFILE

Facility

$662.00

Service Code	HCPCS 8602291
Hospital Charge Code	3007119B
Hospital Revenue Code	302
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$198.60
Rate for Payer: Aetna Medicare Advantage	$198.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.81
Rate for Payer: Cigna Commercial	$331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

PLATELET AB PROFILE

Facility

$662.00

Service Code	HCPCS 8602291
Hospital Charge Code	3007119A
Hospital Revenue Code	302
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$198.60
Rate for Payer: Aetna Medicare Advantage	$198.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.81
Rate for Payer: Cigna Commercial	$331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

PLATELET AB PROFILE

Facility

$224.00

Hospital Charge Code	3035073
Hospital Revenue Code	300
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

PLATELET AB PROFILE

Facility

$662.00

Service Code	HCPCS 8602291
Hospital Charge Code	3007119A
Hospital Revenue Code	302
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$99.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.30

PLATELET AB PROFILE

Facility

$662.00

Service Code	HCPCS 8602291
Hospital Charge Code	3007119B
Hospital Revenue Code	302
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$99.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.30

PLATELET AB PROFILE

Facility

$224.00

Hospital Charge Code	3035073
Hospital Revenue Code	300
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.20
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

PLATELET AGGREGATION(IN VITRO)

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100825
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLATELET AGGREGATION(IN VITRO)

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100825
Hospital Revenue Code	300
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.71
Rate for Payer: Aetna Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.27
Rate for Payer: Cigna Commercial	$24.91
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.40
Rate for Payer: Wellcare Medicare Advantage	$24.91

Know your out-of-pocket cost for care.

All Charges