Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE MESH 2.4/2.7MM 12 HOLE

Facility

$7,953.40

Service Code	HCPCS C1713
Hospital Charge Code	270689659
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.01
Max. Negotiated Rate	$1,924.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,924.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.01

PLATE METAL 5-HOLE 814116005

Facility

$1,369.00

Hospital Charge Code	270632506
Hospital Revenue Code	278
Min. Negotiated Rate	$205.35
Max. Negotiated Rate	$684.50
Rate for Payer: Aetna Commercial	$410.70
Rate for Payer: Aetna Medicare Advantage	$410.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.10
Rate for Payer: Cigna Commercial	$684.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.30
Rate for Payer: Qualcare PPO/HMO/WC	$205.35

PLATE METAL 5-HOLE 814116005

Facility

$1,369.00

Hospital Charge Code	270632506
Hospital Revenue Code	278
Min. Negotiated Rate	$205.35
Max. Negotiated Rate	$331.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.30
Rate for Payer: Qualcare PPO/HMO/WC	$205.35

PLATE METAPH 3.5x125MM 10HOLE

Facility

$4,172.55

Service Code	HCPCS C1713
Hospital Charge Code	270680766
Hospital Revenue Code	278
Min. Negotiated Rate	$625.88
Max. Negotiated Rate	$1,009.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.76
Rate for Payer: Qualcare PPO/HMO/WC	$625.88

PLATE METAPH 3.5x125MM 10HOLE

Facility

$4,172.55

Service Code	HCPCS C1713
Hospital Charge Code	270680766
Hospital Revenue Code	278
Min. Negotiated Rate	$625.88
Max. Negotiated Rate	$2,086.28
Rate for Payer: Aetna Commercial	$1,251.77
Rate for Payer: Aetna Medicare Advantage	$1,251.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,064.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,064.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,064.00
Rate for Payer: Cigna Commercial	$2,086.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.76
Rate for Payer: Qualcare PPO/HMO/WC	$625.88

PLATE METAPH 3.5x125MM 8HOLE

Facility

$3,804.00

Service Code	HCPCS C1713
Hospital Charge Code	270660388
Hospital Revenue Code	278
Min. Negotiated Rate	$570.60
Max. Negotiated Rate	$920.57
Rate for Payer: Qualcare PPO/HMO/WC	$570.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$760.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.57

PLATE METAPH 3.5x125MM 8HOLE

Facility

$3,804.00

Service Code	HCPCS C1713
Hospital Charge Code	270660388
Hospital Revenue Code	278
Min. Negotiated Rate	$570.60
Max. Negotiated Rate	$1,902.00
Rate for Payer: Aetna Commercial	$1,141.20
Rate for Payer: Aetna Medicare Advantage	$1,141.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$970.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$970.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$760.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$970.02
Rate for Payer: Cigna Commercial	$1,902.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.57
Rate for Payer: Qualcare PPO/HMO/WC	$570.60

PLATE METAPH 3.5x190MM 12HOLE

Facility

$5,474.25

Service Code	HCPCS C1713
Hospital Charge Code	270684226
Hospital Revenue Code	278
Min. Negotiated Rate	$821.14
Max. Negotiated Rate	$1,324.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.77
Rate for Payer: Qualcare PPO/HMO/WC	$821.14

PLATE METAPH 3.5x190MM 12HOLE

Facility

$5,474.25

Service Code	HCPCS C1713
Hospital Charge Code	270684226
Hospital Revenue Code	278
Min. Negotiated Rate	$821.14
Max. Negotiated Rate	$2,737.12
Rate for Payer: Aetna Commercial	$1,642.28
Rate for Payer: Aetna Medicare Advantage	$1,642.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,395.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,395.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,094.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,395.93
Rate for Payer: Cigna Commercial	$2,737.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.77
Rate for Payer: Qualcare PPO/HMO/WC	$821.14

PLATE METAPHY 4/5 HOLES 136MM

Facility

$3,867.00

Service Code	HCPCS C1713
Hospital Charge Code	270660391
Hospital Revenue Code	278
Min. Negotiated Rate	$580.05
Max. Negotiated Rate	$1,933.50
Rate for Payer: Aetna Commercial	$1,160.10
Rate for Payer: Aetna Medicare Advantage	$1,160.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$986.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$986.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$773.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$986.09
Rate for Payer: Cigna Commercial	$1,933.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.81
Rate for Payer: Qualcare PPO/HMO/WC	$580.05

PLATE METAPHY 4/5 HOLES 136MM

Facility

$3,867.00

Service Code	HCPCS C1713
Hospital Charge Code	270660391
Hospital Revenue Code	278
Min. Negotiated Rate	$580.05
Max. Negotiated Rate	$935.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$773.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.81
Rate for Payer: Qualcare PPO/HMO/WC	$580.05

PLATE METAPHYS 4.5/3.5 118mm

Facility

$3,804.00

Hospital Charge Code	270669252
Hospital Revenue Code	278
Min. Negotiated Rate	$570.60
Max. Negotiated Rate	$1,902.00
Rate for Payer: Aetna Commercial	$1,141.20
Rate for Payer: Aetna Medicare Advantage	$1,141.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$970.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$970.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$760.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$970.02
Rate for Payer: Cigna Commercial	$1,902.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.57
Rate for Payer: Qualcare PPO/HMO/WC	$570.60

PLATE METAPHYS 4.5/3.5 118mm

Facility

$3,804.00

Hospital Charge Code	270669252
Hospital Revenue Code	278
Min. Negotiated Rate	$570.60
Max. Negotiated Rate	$920.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$760.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.57
Rate for Payer: Qualcare PPO/HMO/WC	$570.60

PLATE METAPHYS 4.5/3.5 190mm

Facility

$5,160.00

Service Code	HCPCS C1713
Hospital Charge Code	270669505
Hospital Revenue Code	278
Min. Negotiated Rate	$774.00
Max. Negotiated Rate	$1,248.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,032.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,248.72
Rate for Payer: Qualcare PPO/HMO/WC	$774.00

PLATE METAPHYS 4.5/3.5 190mm

Facility

$5,160.00

Service Code	HCPCS C1713
Hospital Charge Code	270669505
Hospital Revenue Code	278
Min. Negotiated Rate	$774.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Aetna Commercial	$1,548.00
Rate for Payer: Aetna Medicare Advantage	$1,548.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,315.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,315.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,315.80
Rate for Payer: Cigna Commercial	$2,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,248.72
Rate for Payer: Qualcare PPO/HMO/WC	$774.00

PLATE METAPHYSEAL 4.5/3.5 11H

Facility

$3,996.00

Service Code	HCPCS C1713
Hospital Charge Code	270674861
Hospital Revenue Code	278
Min. Negotiated Rate	$599.40
Max. Negotiated Rate	$1,998.00
Rate for Payer: Aetna Commercial	$1,198.80
Rate for Payer: Aetna Medicare Advantage	$1,198.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,018.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,018.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,018.98
Rate for Payer: Cigna Commercial	$1,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$967.03
Rate for Payer: Qualcare PPO/HMO/WC	$599.40

PLATE METAPHYSEAL 4.5/3.5 11H

Facility

$3,996.00

Service Code	HCPCS C1713
Hospital Charge Code	270674861
Hospital Revenue Code	278
Min. Negotiated Rate	$599.40
Max. Negotiated Rate	$967.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$967.03
Rate for Payer: Qualcare PPO/HMO/WC	$599.40

PLATE METAPHYSEAL 4.5MM 10H

Facility

$12,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270700091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.25
Max. Negotiated Rate	$6,057.50
Rate for Payer: Aetna Commercial	$3,634.50
Rate for Payer: Aetna Medicare Advantage	$3,634.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,089.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,089.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,089.32
Rate for Payer: Cigna Commercial	$6,057.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,931.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,817.25

PLATE METAPHYSEAL 4.5MM 10H

Facility

$12,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270700091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.25
Max. Negotiated Rate	$2,931.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,931.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,817.25

PLATE METAPHYSEAL 6H 3.5x86MM

Facility

$3,902.00

Service Code	HCPCS C1713
Hospital Charge Code	270660390
Hospital Revenue Code	278
Min. Negotiated Rate	$585.30
Max. Negotiated Rate	$1,951.00
Rate for Payer: Aetna Commercial	$1,170.60
Rate for Payer: Aetna Medicare Advantage	$1,170.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$995.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$995.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$995.01
Rate for Payer: Cigna Commercial	$1,951.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.28
Rate for Payer: Qualcare PPO/HMO/WC	$585.30

PLATE METAPHYSEAL 6H 3.5x86MM

Facility

$3,902.00

Service Code	HCPCS C1713
Hospital Charge Code	270660390
Hospital Revenue Code	278
Min. Negotiated Rate	$585.30
Max. Negotiated Rate	$944.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.28
Rate for Payer: Qualcare PPO/HMO/WC	$585.30

PLATE METATARSAL 4H STRAIGHT

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270697018
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$943.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

PLATE METATARSAL 4H STRAIGHT

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270697018
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,170.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

PLATE METATASAL WEDG 2MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270678717
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

PLATE METATASAL WEDG 2MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270678717
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

Know your out-of-pocket cost for care.

All Charges