Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SKYKINE 32MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270686918
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 SKYKINE 32MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270686918
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 SKYL ANT CERV 16X54MM 3L

Facility

$8,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270694859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.75
Max. Negotiated Rate	$4,132.50
Rate for Payer: Aetna Commercial	$2,479.50
Rate for Payer: Aetna Medicare Advantage	$2,479.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,653.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,107.57
Rate for Payer: Cigna Commercial	$4,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,000.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75

PLATE SKYL ANT CERV 16X54MM 3L

Facility

$8,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270694859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.75
Max. Negotiated Rate	$2,000.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,653.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,000.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75

PLATE SKYLINE 32MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270686937
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 32MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270686937
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$1,812.60
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 34MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270689203
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$1,812.60
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 34MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270689203
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 34 MM LEVEL 2

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681013
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 SKYLINE 34 MM LEVEL 2

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681013
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 SKYLINE 42 MM

Facility

$7,290.00

Service Code	HCPCS C1713
Hospital Charge Code	270686283
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

PLATE SKYLINE 42 MM

Facility

$7,290.00

Service Code	HCPCS C1713
Hospital Charge Code	270686283
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$3,645.00
Rate for Payer: Aetna Commercial	$2,187.00
Rate for Payer: Aetna Medicare Advantage	$2,187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,858.95
Rate for Payer: Cigna Commercial	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

PLATE SKYLINE 48 MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681583
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 SKYLINE 48 MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681583
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 SKYLINE 54MM

Facility

$11,075.00

Hospital Charge Code	270665835
Hospital Revenue Code	278
Min. Negotiated Rate	$1,661.25
Max. Negotiated Rate	$2,680.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,680.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,661.25

PLATE SKYLINE 54MM

Facility

$11,075.00

Hospital Charge Code	270665835
Hospital Revenue Code	278
Min. Negotiated Rate	$1,661.25
Max. Negotiated Rate	$5,537.50
Rate for Payer: Aetna Commercial	$3,322.50
Rate for Payer: Aetna Medicare Advantage	$3,322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,824.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,824.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,824.12
Rate for Payer: Cigna Commercial	$5,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,680.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,661.25

PLATE SLIM 34MM HP 34 MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694191
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$7,775.00
Rate for Payer: Aetna Commercial	$4,665.00
Rate for Payer: Aetna Medicare Advantage	$4,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,965.25
Rate for Payer: Cigna Commercial	$7,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

PLATE SLIM 34MM HP 34 MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694191
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$3,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

PLATE SLIM 3 LEVEL 49MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695651
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM 3 LEVEL 49MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695651
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$5,775.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM 3 LEVEL 52MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695652
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$5,775.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM 3 LEVEL 52MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695652
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM MEDIAL 15H

Facility

$14,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$4,320.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

PLATE SLIM MEDIAL 15H

Facility

$14,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

PLATE SMALL MEDAIL

Facility

$4,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270686751
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,308.00
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

Know your out-of-pocket cost for care.

All Charges