Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SAPPH XCERV SYS 1LEV 9MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694281
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE SAPPH XCERV SYS 1LEV 9MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694281
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE SCP 150mm90DEG 118109006

Facility

$2,228.10

Hospital Charge Code	270625765
Hospital Revenue Code	278
Min. Negotiated Rate	$334.21
Max. Negotiated Rate	$539.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$539.20
Rate for Payer: Qualcare PPO/HMO/WC	$334.21

PLATE SCP 150mm90DEG 118109006

Facility

$2,228.10

Hospital Charge Code	270625765
Hospital Revenue Code	278
Min. Negotiated Rate	$334.21
Max. Negotiated Rate	$1,114.05
Rate for Payer: Aetna Commercial	$668.43
Rate for Payer: Aetna Medicare Advantage	$668.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$568.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$568.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$568.17
Rate for Payer: Cigna Commercial	$1,114.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$539.20
Rate for Payer: Qualcare PPO/HMO/WC	$334.21

PLATE SCREW 6.5X30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697297
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SCREW 6.5X30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697297
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SDK CERV 23.0MM 876-123

Facility

$4,460.00

Hospital Charge Code	270617699
Hospital Revenue Code	278
Min. Negotiated Rate	$669.00
Max. Negotiated Rate	$2,230.00
Rate for Payer: Aetna Commercial	$1,338.00
Rate for Payer: Aetna Medicare Advantage	$1,338.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,137.30
Rate for Payer: Cigna Commercial	$2,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.32
Rate for Payer: Qualcare PPO/HMO/WC	$669.00

PLATE SDK CERV 23.0MM 876-123

Facility

$4,460.00

Hospital Charge Code	270617699
Hospital Revenue Code	278
Min. Negotiated Rate	$669.00
Max. Negotiated Rate	$1,079.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.32
Rate for Payer: Qualcare PPO/HMO/WC	$669.00

PLATE SDK CERV 25.0MM 876-125

Facility

$4,061.65

Hospital Charge Code	270615263
Hospital Revenue Code	278
Min. Negotiated Rate	$609.25
Max. Negotiated Rate	$2,030.83
Rate for Payer: Aetna Commercial	$1,218.49
Rate for Payer: Aetna Medicare Advantage	$1,218.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.72
Rate for Payer: Cigna Commercial	$2,030.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.92
Rate for Payer: Qualcare PPO/HMO/WC	$609.25

PLATE SDK CERV 25.0MM 876-125

Facility

$4,061.65

Hospital Charge Code	270615263
Hospital Revenue Code	278
Min. Negotiated Rate	$609.25
Max. Negotiated Rate	$982.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.92
Rate for Payer: Qualcare PPO/HMO/WC	$609.25

PLATE SDK CERV 42.5MM 876-142

Facility

$4,061.65

Hospital Charge Code	270614733
Hospital Revenue Code	278
Min. Negotiated Rate	$609.25
Max. Negotiated Rate	$982.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.92
Rate for Payer: Qualcare PPO/HMO/WC	$609.25

PLATE SDK CERV 42.5MM 876-142

Facility

$4,061.65

Hospital Charge Code	270614733
Hospital Revenue Code	278
Min. Negotiated Rate	$609.25
Max. Negotiated Rate	$2,030.83
Rate for Payer: Aetna Commercial	$1,218.49
Rate for Payer: Aetna Medicare Advantage	$1,218.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.72
Rate for Payer: Cigna Commercial	$2,030.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.92
Rate for Payer: Qualcare PPO/HMO/WC	$609.25

PLATE SDK CERV 50.0MM 876-150

Facility

$4,855.25

Hospital Charge Code	270618019
Hospital Revenue Code	278
Min. Negotiated Rate	$728.29
Max. Negotiated Rate	$1,174.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$971.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,174.97
Rate for Payer: Qualcare PPO/HMO/WC	$728.29

PLATE SDK CERV 50.0MM 876-150

Facility

$4,855.25

Hospital Charge Code	270618019
Hospital Revenue Code	278
Min. Negotiated Rate	$728.29
Max. Negotiated Rate	$2,427.62
Rate for Payer: Aetna Commercial	$1,456.58
Rate for Payer: Aetna Medicare Advantage	$1,456.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,238.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,238.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$971.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,238.09
Rate for Payer: Cigna Commercial	$2,427.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,174.97
Rate for Payer: Qualcare PPO/HMO/WC	$728.29

PLATE SDK CERV 52.5MM 876-152

Facility

$4,855.25

Hospital Charge Code	270618014
Hospital Revenue Code	278
Min. Negotiated Rate	$728.29
Max. Negotiated Rate	$2,427.62
Rate for Payer: Aetna Commercial	$1,456.58
Rate for Payer: Aetna Medicare Advantage	$1,456.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,238.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,238.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$971.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,238.09
Rate for Payer: Cigna Commercial	$2,427.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,174.97
Rate for Payer: Qualcare PPO/HMO/WC	$728.29

PLATE SDK CERV 52.5MM 876-152

Facility

$4,855.25

Hospital Charge Code	270618014
Hospital Revenue Code	278
Min. Negotiated Rate	$728.29
Max. Negotiated Rate	$1,174.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$971.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,174.97
Rate for Payer: Qualcare PPO/HMO/WC	$728.29

PLATE SDK CERV 57.5MM 876-157

Facility

$4,424.00

Hospital Charge Code	270616042
Hospital Revenue Code	278
Min. Negotiated Rate	$663.60
Max. Negotiated Rate	$2,212.00
Rate for Payer: Aetna Commercial	$1,327.20
Rate for Payer: Aetna Medicare Advantage	$1,327.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$884.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,128.12
Rate for Payer: Cigna Commercial	$2,212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,070.61
Rate for Payer: Qualcare PPO/HMO/WC	$663.60

PLATE SDK CERV 57.5MM 876-157

Facility

$4,424.00

Hospital Charge Code	270616042
Hospital Revenue Code	278
Min. Negotiated Rate	$663.60
Max. Negotiated Rate	$1,070.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$884.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,070.61
Rate for Payer: Qualcare PPO/HMO/WC	$663.60

PLATE SDK CNVGT 15.0MM 870-294

Facility

$3,432.85

Hospital Charge Code	270614967
Hospital Revenue Code	278
Min. Negotiated Rate	$514.93
Max. Negotiated Rate	$1,716.42
Rate for Payer: Aetna Commercial	$1,029.86
Rate for Payer: Aetna Medicare Advantage	$1,029.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$875.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$875.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$875.38
Rate for Payer: Cigna Commercial	$1,716.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.75
Rate for Payer: Qualcare PPO/HMO/WC	$514.93

PLATE SDK CNVGT 15.0MM 870-294

Facility

$3,432.85

Hospital Charge Code	270614967
Hospital Revenue Code	278
Min. Negotiated Rate	$514.93
Max. Negotiated Rate	$830.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.75
Rate for Payer: Qualcare PPO/HMO/WC	$514.93

PLATE SDK CNVGT 30.0MM 871-130

Facility

$2,903.25

Hospital Charge Code	270609814
Hospital Revenue Code	278
Min. Negotiated Rate	$435.49
Max. Negotiated Rate	$702.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.59
Rate for Payer: Qualcare PPO/HMO/WC	$435.49

PLATE SDK CNVGT 30.0MM 871-130

Facility

$2,903.25

Hospital Charge Code	270609814
Hospital Revenue Code	278
Min. Negotiated Rate	$435.49
Max. Negotiated Rate	$1,451.62
Rate for Payer: Aetna Commercial	$870.98
Rate for Payer: Aetna Medicare Advantage	$870.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$740.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$740.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$740.33
Rate for Payer: Cigna Commercial	$1,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.59
Rate for Payer: Qualcare PPO/HMO/WC	$435.49

PLATE SDK CNVGT 40.0MM 871-140

Facility

$3,089.65

Hospital Charge Code	270613168
Hospital Revenue Code	278
Min. Negotiated Rate	$463.45
Max. Negotiated Rate	$747.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.70
Rate for Payer: Qualcare PPO/HMO/WC	$463.45

PLATE SDK CNVGT 40.0MM 871-140

Facility

$3,089.65

Hospital Charge Code	270613168
Hospital Revenue Code	278
Min. Negotiated Rate	$463.45
Max. Negotiated Rate	$1,544.83
Rate for Payer: Aetna Commercial	$926.89
Rate for Payer: Aetna Medicare Advantage	$926.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.86
Rate for Payer: Cigna Commercial	$1,544.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.70
Rate for Payer: Qualcare PPO/HMO/WC	$463.45

PLATE SDK CNVGT 42.5MM 871-142

Facility

$3,707.25

Hospital Charge Code	270614653
Hospital Revenue Code	278
Min. Negotiated Rate	$556.09
Max. Negotiated Rate	$1,853.62
Rate for Payer: Aetna Commercial	$1,112.17
Rate for Payer: Aetna Medicare Advantage	$1,112.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$945.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$945.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$741.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$945.35
Rate for Payer: Cigna Commercial	$1,853.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$897.15
Rate for Payer: Qualcare PPO/HMO/WC	$556.09

Know your out-of-pocket cost for care.

All Charges