Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE MINI LOCKED LEFT 24x43MM

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270673610
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

PLATE MINI LOCKED LEFT 24x43MM

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270673610
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$2,860.00
Rate for Payer: Aetna Commercial	$1,716.00
Rate for Payer: Aetna Medicare Advantage	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,458.60
Rate for Payer: Cigna Commercial	$2,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

PLATE MINI-STRAIGHT 5-HOLE

Facility

$92.00

Hospital Charge Code	1602655
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PLATE MINI-STRAIGHT 5-HOLE

Facility

$92.00

Hospital Charge Code	1602655
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PLATE MINI-STRAIGHT 6-HOLE

Facility

$92.00

Hospital Charge Code	1602663
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PLATE MINI-STRAIGHT 6-HOLE

Facility

$92.00

Hospital Charge Code	1602663
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PLATE MLP TENSION 4HOLE 2mm

Facility

$2,445.00

Hospital Charge Code	270662332
Hospital Revenue Code	278
Min. Negotiated Rate	$366.75
Max. Negotiated Rate	$591.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.69
Rate for Payer: Qualcare PPO/HMO/WC	$366.75

PLATE MLP TENSION 4HOLE 2mm

Facility

$2,445.00

Hospital Charge Code	270662332
Hospital Revenue Code	278
Min. Negotiated Rate	$366.75
Max. Negotiated Rate	$1,222.50
Rate for Payer: Aetna Commercial	$733.50
Rate for Payer: Aetna Medicare Advantage	$733.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.48
Rate for Payer: Cigna Commercial	$1,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.69
Rate for Payer: Qualcare PPO/HMO/WC	$366.75

PLATE MNTR H/H X-CONN 28MM

Facility

$5,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270663780
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$1,253.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR H/H X-CONN 28MM

Facility

$5,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270663780
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$2,590.00
Rate for Payer: Aetna Commercial	$1,554.00
Rate for Payer: Aetna Medicare Advantage	$1,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,320.90
Rate for Payer: Cigna Commercial	$2,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR H/H X-CONN 35MM

Facility

$5,180.00

Hospital Charge Code	270663784
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$1,253.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR H/H X-CONN 35MM

Facility

$5,180.00

Hospital Charge Code	270663784
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$2,590.00
Rate for Payer: Aetna Commercial	$1,554.00
Rate for Payer: Aetna Medicare Advantage	$1,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,320.90
Rate for Payer: Cigna Commercial	$2,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR OC SMALL

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270677388
Hospital Revenue Code	278
Min. Negotiated Rate	$2,398.50
Max. Negotiated Rate	$3,869.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,398.50

PLATE MNTR OC SMALL

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270677388
Hospital Revenue Code	278
Min. Negotiated Rate	$2,398.50
Max. Negotiated Rate	$7,995.00
Rate for Payer: Aetna Commercial	$4,797.00
Rate for Payer: Aetna Medicare Advantage	$4,797.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,077.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,077.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,077.45
Rate for Payer: Cigna Commercial	$7,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,398.50

PLATE MODULUS XLIF DS 10MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697064
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATE MODULUS XLIF DS 10MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697064
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$4,725.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATEMODULUSXLIFDUALSIDE 8MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$4,725.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATEMODULUSXLIFDUALSIDE 8MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATE MODULUS XLIF MOD 12MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695492
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$4,725.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATE MODULUS XLIF MOD 12MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695492
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATEMONET4HWIDEEXTRA7MM$$N/C

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270696627
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

PLATEMONET4HWIDEEXTRA7MM$$N/C

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270696627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$2,835.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE MONEY XWIDE 4H 8MM

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270697689
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 MONEY XWIDE 4H 8MM

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270697689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$2,835.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE MONO PYRENEES 42 MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270698871
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

Know your out-of-pocket cost for care.

All Charges