Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SEMI TUBULAR 7-HOLE***

Facility

$123.00

Hospital Charge Code	1602465
Hospital Revenue Code	274
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$36.90
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

PLATE SEMI TUBULAR 8-HOLE***

Facility

$136.00

Hospital Charge Code	1602473
Hospital Revenue Code	274
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.91
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

PLATE SEMI TUBULAR 8-HOLE***

Facility

$136.00

Hospital Charge Code	1602473
Hospital Revenue Code	274
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Medicare Advantage	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.68
Rate for Payer: Cigna Commercial	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.91
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

PLATE SEMI TUBULAR 9-HOLE***

Facility

$145.00

Hospital Charge Code	1602481
Hospital Revenue Code	274
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

PLATE SEMI TUBULAR 9-HOLE***

Facility

$145.00

Hospital Charge Code	1602481
Hospital Revenue Code	274
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

PLATE SHOULDER 4HOLE LT SSP-L4

Facility

$5,704.00

Hospital Charge Code	270635023
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$1,380.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

PLATE SHOULDER 4HOLE LT SSP-L4

Facility

$5,704.00

Hospital Charge Code	270635023
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$2,852.00
Rate for Payer: Aetna Commercial	$1,711.20
Rate for Payer: Aetna Medicare Advantage	$1,711.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.52
Rate for Payer: Cigna Commercial	$2,852.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

PLATE SHOULDER 4HOLE RT SSPR4

Facility

$5,704.00

Hospital Charge Code	270634956
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$2,852.00
Rate for Payer: Aetna Commercial	$1,711.20
Rate for Payer: Aetna Medicare Advantage	$1,711.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.52
Rate for Payer: Cigna Commercial	$2,852.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

PLATE SHOULDER 4HOLE RT SSPR4

Facility

$5,704.00

Hospital Charge Code	270634956
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$1,380.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

PLATE SKY 2 LEVEL TI 18MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676512
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 SKY 2 LEVEL TI 18MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676512
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 SKY 2 LEVEL TI 20MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676511
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 SKY 2 LEVEL TI 20MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676511
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 SKY 2 LEVEL TI 30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679877
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 SKY 2 LEVEL TI 30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679877
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 SKY 2 LEVEL TI 38MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270674901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKY 2 LEVEL TI 38MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270674901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKY 3 LEVEL TI 48MM

Facility

$7,250.00

Hospital Charge Code	270668252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,175.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 48MM

Facility

$7,250.00

Hospital Charge Code	270668252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 51MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 51MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Aetna Commercial	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 54MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,175.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 54MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 57MM

Facility

$7,250.00

Hospital Charge Code	270668466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 57MM

Facility

$7,250.00

Hospital Charge Code	270668466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,175.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

Know your out-of-pocket cost for care.

All Charges