Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE OPENING WEDGE 0 MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270679185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,079.00
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPENING WEDGE 5MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270663146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,079.00
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPENING WEDGE 5MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270663146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPEN WEDGE 3MM

Facility

$8,540.00

Service Code	HCPCS C1713
Hospital Charge Code	270700341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.00
Max. Negotiated Rate	$4,270.00
Rate for Payer: Aetna Commercial	$2,562.00
Rate for Payer: Aetna Medicare Advantage	$2,562.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,177.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,177.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,708.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,177.70
Rate for Payer: Cigna Commercial	$4,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,066.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.00

PLATE OPEN WEDGE 3MM

Facility

$8,540.00

Service Code	HCPCS C1713
Hospital Charge Code	270700341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.00
Max. Negotiated Rate	$2,066.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,708.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,066.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.00

PLATE OPEN WEDGE 4.5

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679764
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 OPEN WEDGE 4.5

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679764
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 OPEN WEDGE 4.5MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656537
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$1,374.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 4.5MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656537
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$2,840.00
Rate for Payer: Aetna Commercial	$1,704.00
Rate for Payer: Aetna Medicare Advantage	$1,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,448.40
Rate for Payer: Cigna Commercial	$2,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 4MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270653100
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$1,374.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 4MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270653100
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$2,840.00
Rate for Payer: Aetna Commercial	$1,704.00
Rate for Payer: Aetna Medicare Advantage	$1,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,448.40
Rate for Payer: Cigna Commercial	$2,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 5mm RIGHT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679885
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

PLATE OPEN WEDGE 5mm RIGHT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679885
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 ORBITALFL 0.3m SM 017106

Facility

$3,135.00

Hospital Charge Code	270642177
Hospital Revenue Code	278
Min. Negotiated Rate	$470.25
Max. Negotiated Rate	$1,567.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$940.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$799.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$799.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$627.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$799.42
Rate for Payer: Cigna Commercial	$1,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.67
Rate for Payer: Qualcare PPO/HMO/WC	$470.25

PLATE ORBITALFL 0.3m SM 017106

Facility

$3,135.00

Hospital Charge Code	270642177
Hospital Revenue Code	278
Min. Negotiated Rate	$470.25
Max. Negotiated Rate	$758.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$627.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.67
Rate for Payer: Qualcare PPO/HMO/WC	$470.25

PLATE ORTHO 6 CALC SLIDE

Facility

$7,490.00

Hospital Charge Code	270677101
Hospital Revenue Code	278
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$3,745.00
Rate for Payer: Aetna Commercial	$2,247.00
Rate for Payer: Aetna Medicare Advantage	$2,247.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,909.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,909.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,909.95
Rate for Payer: Cigna Commercial	$3,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,812.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,123.50

PLATE ORTHO 6 CALC SLIDE

Facility

$7,490.00

Hospital Charge Code	270677101
Hospital Revenue Code	278
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$1,812.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,812.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,123.50

PLATE ORTHOLOC 3DI TIBIA SM

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270700813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.25
Max. Negotiated Rate	$1,799.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25

PLATE ORTHOLOC 3DI TIBIA SM

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270700813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.25
Max. Negotiated Rate	$3,717.50
Rate for Payer: Aetna Commercial	$2,230.50
Rate for Payer: Aetna Medicare Advantage	$2,230.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,895.92
Rate for Payer: Cigna Commercial	$3,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25

PLATE ORTHOLOC LG LP HOOK 3DI

Facility

$13,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270700519
Hospital Revenue Code	278
Min. Negotiated Rate	$2,036.25
Max. Negotiated Rate	$3,285.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25

PLATE ORTHOLOC LG LP HOOK 3DI

Facility

$13,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270700519
Hospital Revenue Code	278
Min. Negotiated Rate	$2,036.25
Max. Negotiated Rate	$6,787.50
Rate for Payer: Aetna Commercial	$4,072.50
Rate for Payer: Aetna Medicare Advantage	$4,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,461.62
Rate for Payer: Cigna Commercial	$6,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25

PLATE PEG TIBIAL SZ 2 59702502

Facility

$5,987.00

Hospital Charge Code	270630186
Hospital Revenue Code	278
Min. Negotiated Rate	$898.05
Max. Negotiated Rate	$1,448.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,197.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.85
Rate for Payer: Qualcare PPO/HMO/WC	$898.05

PLATE PEG TIBIAL SZ 2 59702502

Facility

$5,987.00

Hospital Charge Code	270630186
Hospital Revenue Code	278
Min. Negotiated Rate	$898.05
Max. Negotiated Rate	$2,993.50
Rate for Payer: Aetna Commercial	$1,796.10
Rate for Payer: Aetna Medicare Advantage	$1,796.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,526.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,526.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,197.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,526.68
Rate for Payer: Cigna Commercial	$2,993.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.85
Rate for Payer: Qualcare PPO/HMO/WC	$898.05

PLATE PERIARTICULAR 23470206

Facility

$2,911.60

Hospital Charge Code	270632307
Hospital Revenue Code	278
Min. Negotiated Rate	$436.74
Max. Negotiated Rate	$1,455.80
Rate for Payer: Aetna Commercial	$873.48
Rate for Payer: Aetna Medicare Advantage	$873.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.46
Rate for Payer: Cigna Commercial	$1,455.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.61
Rate for Payer: Qualcare PPO/HMO/WC	$436.74

PLATE PERIARTICULAR 23470206

Facility

$2,911.60

Hospital Charge Code	270632307
Hospital Revenue Code	278
Min. Negotiated Rate	$436.74
Max. Negotiated Rate	$704.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.61
Rate for Payer: Qualcare PPO/HMO/WC	$436.74

Know your out-of-pocket cost for care.

All Charges