Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

PLATE SMALL RT 3.5X4.5

Facility

$12,751.20

Service Code	HCPCS C1713
Hospital Charge Code	270693767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.68
Max. Negotiated Rate	$6,375.60
Rate for Payer: Aetna Commercial	$3,825.36
Rate for Payer: Aetna Medicare Advantage	$3,825.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.56
Rate for Payer: Cigna Commercial	$6,375.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.68

PLATE SMALL RT 3.5X4.5

Facility

$12,751.20

Service Code	HCPCS C1713
Hospital Charge Code	270693767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.68
Max. Negotiated Rate	$3,085.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.68

PLATE SM T 3 HOLE

Facility

$190.00

Hospital Charge Code	1602697
Hospital Revenue Code	274
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$45.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PLATE SM T 3 HOLE

Facility

$190.00

Hospital Charge Code	1602697
Hospital Revenue Code	274
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PLATE SM T 4 HOLE

Facility

$201.00

Hospital Charge Code	1602705
Hospital Revenue Code	274
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$48.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.64
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

PLATE SM T 4 HOLE

Facility

$201.00

Hospital Charge Code	1602705
Hospital Revenue Code	274
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna Commercial	$60.30
Rate for Payer: Aetna Medicare Advantage	$60.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.26
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.64
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

PLATE SM T 5 HOLE

Facility

$223.00

Hospital Charge Code	1602713
Hospital Revenue Code	274
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$53.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.97
Rate for Payer: Qualcare PPO/HMO/WC	$33.45

PLATE SM T 5 HOLE

Facility

$223.00

Hospital Charge Code	1602713
Hospital Revenue Code	274
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$111.50
Rate for Payer: Aetna Commercial	$66.90
Rate for Payer: Aetna Medicare Advantage	$66.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.87
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.97
Rate for Payer: Qualcare PPO/HMO/WC	$33.45

PLATE SPINAL ACP 1LEV 12MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694440
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE SPINAL ACP 1LEV 12MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694440
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE SPINAL ACP 1 LEVELX11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694441
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE SPINAL ACP 1 LEVELX11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694441
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE SPINAL FIXAT 2LEVEL 34MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694320
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$5,175.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE SPINAL FIXAT 2LEVEL 34MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694320
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE SPOON 5-HOLE

Facility

$446.00

Hospital Charge Code	1602754
Hospital Revenue Code	274
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$107.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.93
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

PLATE SPOON 5-HOLE

Facility

$446.00

Hospital Charge Code	1602754
Hospital Revenue Code	274
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.93
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

PLATE SPOON 6-H

Facility

$479.00

Hospital Charge Code	1602762
Hospital Revenue Code	274
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$239.50
Rate for Payer: Aetna Commercial	$143.70
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.92
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

PLATE SPOON 6-H

Facility

$479.00

Hospital Charge Code	1602762
Hospital Revenue Code	274
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$115.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.92
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

PLATE STANDARD 4 HOLE RIGHT

Facility

$4,475.00

Hospital Charge Code	270664369
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 STANDARD 4 HOLE RIGHT

Facility

$4,475.00

Hospital Charge Code	270664369
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 STANDARD LARGE

Facility

$5,287.75

Service Code	HCPCS C1713
Hospital Charge Code	270693998
Hospital Revenue Code	278
Min. Negotiated Rate	$793.16
Max. Negotiated Rate	$1,279.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,057.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,279.64
Rate for Payer: Qualcare PPO/HMO/WC	$793.16

PLATE STANDARD LARGE

Facility

$5,287.75

Service Code	HCPCS C1713
Hospital Charge Code	270693998
Hospital Revenue Code	278
Min. Negotiated Rate	$793.16
Max. Negotiated Rate	$2,643.88
Rate for Payer: Aetna Commercial	$1,586.33
Rate for Payer: Aetna Medicare Advantage	$1,586.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,348.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,348.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,057.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,348.38
Rate for Payer: Cigna Commercial	$2,643.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,279.64
Rate for Payer: Qualcare PPO/HMO/WC	$793.16

PLATE STANDARD RIGHT DVR

Facility

$5,550.00

Hospital Charge Code	270664021
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

PLATE STANDARD RIGHT DVR

Facility

$5,550.00

Hospital Charge Code	270664021
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$1,665.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

Know your out-of-pocket cost for care.

All Charges