Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE STRAIGHT 2.4MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694872
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 STRAIGHT 6 HOLE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270698544
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

PLATE STRAIGHT 6 HOLE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270698544
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

PLATE STRAIGHT 6HOLE 2.0MM

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694674
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 STRAIGHT 6HOLE 2.0MM

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694674
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 STRAIGHT 8 HOLE W / COMP

Facility

$4,111.25

Service Code	HCPCS C1713
Hospital Charge Code	270701753
Hospital Revenue Code	278
Min. Negotiated Rate	$616.69
Max. Negotiated Rate	$994.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$822.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$994.92
Rate for Payer: Qualcare PPO/HMO/WC	$616.69

PLATE STRAIGHT 8 HOLE W / COMP

Facility

$4,111.25

Service Code	HCPCS C1713
Hospital Charge Code	270701753
Hospital Revenue Code	278
Min. Negotiated Rate	$616.69
Max. Negotiated Rate	$2,055.62
Rate for Payer: Aetna Commercial	$1,233.38
Rate for Payer: Aetna Medicare Advantage	$1,233.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,048.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,048.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$822.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,048.37
Rate for Payer: Cigna Commercial	$2,055.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$994.92
Rate for Payer: Qualcare PPO/HMO/WC	$616.69

PLATE STRA TUB 8 HOLE

Facility

$2,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270701131
Hospital Revenue Code	278
Min. Negotiated Rate	$387.75
Max. Negotiated Rate	$625.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$517.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.57
Rate for Payer: Qualcare PPO/HMO/WC	$387.75

PLATE STRA TUB 8 HOLE

Facility

$2,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270701131
Hospital Revenue Code	278
Min. Negotiated Rate	$387.75
Max. Negotiated Rate	$1,292.50
Rate for Payer: Aetna Commercial	$775.50
Rate for Payer: Aetna Medicare Advantage	$775.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$659.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$659.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$517.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$659.17
Rate for Payer: Cigna Commercial	$1,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.57
Rate for Payer: Qualcare PPO/HMO/WC	$387.75

PLATE STRM STRAIGHT 6HOLE

Facility

$5,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270694321
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$1,337.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.05
Rate for Payer: Qualcare PPO/HMO/WC	$828.75

PLATE STRM STRAIGHT 6HOLE

Facility

$5,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270694321
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$2,762.50
Rate for Payer: Aetna Commercial	$1,657.50
Rate for Payer: Aetna Medicare Advantage	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,408.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,408.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,408.88
Rate for Payer: Cigna Commercial	$2,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.05
Rate for Payer: Qualcare PPO/HMO/WC	$828.75

PLATE STR TUB 6 HOL ORTHOLOG

Facility

$12,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270701111
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.50
Max. Negotiated Rate	$6,255.00
Rate for Payer: Aetna Commercial	$3,753.00
Rate for Payer: Aetna Medicare Advantage	$3,753.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,190.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,190.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,502.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,190.05
Rate for Payer: Cigna Commercial	$6,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.50

PLATE STR TUB 6 HOL ORTHOLOG

Facility

$12,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270701111
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.50
Max. Negotiated Rate	$3,027.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,502.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.50

PLATE SUPCOND 90x255 118109010

Facility

$2,227.10

Hospital Charge Code	270632342
Hospital Revenue Code	278
Min. Negotiated Rate	$334.06
Max. Negotiated Rate	$1,113.55
Rate for Payer: Aetna Commercial	$668.13
Rate for Payer: Aetna Medicare Advantage	$668.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.91
Rate for Payer: Cigna Commercial	$1,113.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.96
Rate for Payer: Qualcare PPO/HMO/WC	$334.06

PLATE SUPCOND 90x255 118109010

Facility

$2,227.10

Hospital Charge Code	270632342
Hospital Revenue Code	278
Min. Negotiated Rate	$334.06
Max. Negotiated Rate	$538.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.96
Rate for Payer: Qualcare PPO/HMO/WC	$334.06

PLATE SUPPORT SINUS TARSI RT M

Facility

$5,981.25

Service Code	HCPCS C1713
Hospital Charge Code	270701521
Hospital Revenue Code	278
Min. Negotiated Rate	$897.19
Max. Negotiated Rate	$1,447.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.46
Rate for Payer: Qualcare PPO/HMO/WC	$897.19

PLATE SUPPORT SINUS TARSI RT M

Facility

$5,981.25

Service Code	HCPCS C1713
Hospital Charge Code	270701521
Hospital Revenue Code	278
Min. Negotiated Rate	$897.19
Max. Negotiated Rate	$2,990.62
Rate for Payer: Aetna Commercial	$1,794.38
Rate for Payer: Aetna Medicare Advantage	$1,794.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,525.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,525.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,525.22
Rate for Payer: Cigna Commercial	$2,990.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.46
Rate for Payer: Qualcare PPO/HMO/WC	$897.19

PLATE SUPRA 90 150mm 118109006

Facility

$2,084.85

Hospital Charge Code	270605765
Hospital Revenue Code	278
Min. Negotiated Rate	$312.73
Max. Negotiated Rate	$504.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$416.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.53
Rate for Payer: Qualcare PPO/HMO/WC	$312.73

PLATE SUPRA 90 150mm 118109006

Facility

$2,084.85

Hospital Charge Code	270605765
Hospital Revenue Code	278
Min. Negotiated Rate	$312.73
Max. Negotiated Rate	$1,042.42
Rate for Payer: Aetna Commercial	$625.46
Rate for Payer: Aetna Medicare Advantage	$625.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$416.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.64
Rate for Payer: Cigna Commercial	$1,042.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.53
Rate for Payer: Qualcare PPO/HMO/WC	$312.73

PLATE SUPRA 90 205mm 118109008

Facility

$2,112.00

Hospital Charge Code	270625766
Hospital Revenue Code	278
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$511.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.10
Rate for Payer: Qualcare PPO/HMO/WC	$316.80

PLATE SUPRA 90 205mm 118109008

Facility

$2,112.00

Hospital Charge Code	270625766
Hospital Revenue Code	278
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$1,056.00
Rate for Payer: Aetna Commercial	$633.60
Rate for Payer: Aetna Medicare Advantage	$633.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.56
Rate for Payer: Cigna Commercial	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.10
Rate for Payer: Qualcare PPO/HMO/WC	$316.80

PLATE SUPR MID CURV 10H 122MM

Facility

$8,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270673668
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,020.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,252.50

PLATE SUPR MID CURV 10H 122MM

Facility

$8,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270673668
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$4,175.00
Rate for Payer: Aetna Commercial	$2,505.00
Rate for Payer: Aetna Medicare Advantage	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,129.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,129.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,129.25
Rate for Payer: Cigna Commercial	$4,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,252.50

PLATE SYN 12H 1.5 SCR 446.22

Facility

$1,220.00

Hospital Charge Code	270619572
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$610.00
Rate for Payer: Aetna Commercial	$366.00
Rate for Payer: Aetna Medicare Advantage	$366.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.10
Rate for Payer: Cigna Commercial	$610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$183.00

PLATE SYN 12H 1.5 SCR 446.22

Facility

$1,220.00

Hospital Charge Code	270619572
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$295.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$183.00

Know your out-of-pocket cost for care.

All Charges