Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE TIBIAL 3.5LCP 10HOLES

Facility

$6,448.85

Service Code	HCPCS C1713
Hospital Charge Code	270645819
Hospital Revenue Code	278
Min. Negotiated Rate	$967.33
Max. Negotiated Rate	$1,560.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.62
Rate for Payer: Qualcare PPO/HMO/WC	$967.33

PLATE TIBIAL 5-HOLE STD LEFT

Facility

$8,100.00

Hospital Charge Code	270648240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Commercial	$2,430.00
Rate for Payer: Aetna Medicare Advantage	$2,430.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,065.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,065.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,065.50
Rate for Payer: Cigna Commercial	$4,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,960.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.00

PLATE TIBIAL 5-HOLE STD LEFT

Facility

$8,100.00

Hospital Charge Code	270648240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$1,960.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,960.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.00

PLATE TIBIAL 67 OSS 150420

Facility

$12,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270638563
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.00
Max. Negotiated Rate	$6,240.00
Rate for Payer: Aetna Commercial	$3,744.00
Rate for Payer: Aetna Medicare Advantage	$3,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,182.40
Rate for Payer: Cigna Commercial	$6,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

PLATE TIBIAL 67 OSS 150420

Facility

$12,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270638563
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.00
Max. Negotiated Rate	$3,020.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

PLATE TIBIAL 6-HOLE/118mm RT

Facility

$5,485.85

Hospital Charge Code	270636087
Hospital Revenue Code	278
Min. Negotiated Rate	$822.88
Max. Negotiated Rate	$2,742.93
Rate for Payer: Aetna Commercial	$1,645.76
Rate for Payer: Aetna Medicare Advantage	$1,645.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,097.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,398.89
Rate for Payer: Cigna Commercial	$2,742.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.58
Rate for Payer: Qualcare PPO/HMO/WC	$822.88

PLATE TIBIAL 6-HOLE/118mm RT

Facility

$5,485.85

Hospital Charge Code	270636087
Hospital Revenue Code	278
Min. Negotiated Rate	$822.88
Max. Negotiated Rate	$1,327.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,097.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.58
Rate for Payer: Qualcare PPO/HMO/WC	$822.88

PLATE TIBIAL 6HOLE 130mm LEFT

Facility

$5,020.00

Hospital Charge Code	270643715
Hospital Revenue Code	278
Min. Negotiated Rate	$753.00
Max. Negotiated Rate	$2,510.00
Rate for Payer: Aetna Commercial	$1,506.00
Rate for Payer: Aetna Medicare Advantage	$1,506.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,280.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,280.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,280.10
Rate for Payer: Cigna Commercial	$2,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,214.84
Rate for Payer: Qualcare PPO/HMO/WC	$753.00

PLATE TIBIAL 6HOLE 130mm LEFT

Facility

$5,020.00

Hospital Charge Code	270643715
Hospital Revenue Code	278
Min. Negotiated Rate	$753.00
Max. Negotiated Rate	$1,214.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,004.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,214.84
Rate for Payer: Qualcare PPO/HMO/WC	$753.00

PLATE TIBIAL 75mm CRU T 141234

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270636752
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE TIBIAL 75mm CRU T 141234

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270636752
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE TIBIAL 83mm 141226

Facility

$7,890.00

Hospital Charge Code	270637544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.50
Max. Negotiated Rate	$3,945.00
Rate for Payer: Aetna Commercial	$2,367.00
Rate for Payer: Aetna Medicare Advantage	$2,367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,578.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,011.95
Rate for Payer: Cigna Commercial	$3,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,909.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.50

PLATE TIBIAL 83mm 141226

Facility

$7,890.00

Hospital Charge Code	270637544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.50
Max. Negotiated Rate	$1,909.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,909.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.50

PLATE TIBIAL 8-HOLE 4.5 240041

Facility

$4,682.25

Hospital Charge Code	270632183
Hospital Revenue Code	278
Min. Negotiated Rate	$702.34
Max. Negotiated Rate	$1,133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.10
Rate for Payer: Qualcare PPO/HMO/WC	$702.34

PLATE TIBIAL 8-HOLE 4.5 240041

Facility

$4,682.25

Hospital Charge Code	270632183
Hospital Revenue Code	278
Min. Negotiated Rate	$702.34
Max. Negotiated Rate	$2,341.12
Rate for Payer: Aetna Commercial	$1,404.67
Rate for Payer: Aetna Medicare Advantage	$1,404.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,193.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,193.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,193.97
Rate for Payer: Cigna Commercial	$2,341.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.10
Rate for Payer: Qualcare PPO/HMO/WC	$702.34

PLATE TIBIAL BEARING 12x71/75

Facility

$5,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270638582
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,540.50
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

PLATE TIBIAL BEARING 12x71/75

Facility

$5,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270638582
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

PLATE TIBIAL CRUCIATE 71mm

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270639680
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE TIBIAL CRUCIATE 71mm

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270639680
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE TIBIA LF 2 HOLE 95MM

Facility

$12,236.15

Service Code	HCPCS C1713
Hospital Charge Code	270699118
Hospital Revenue Code	278
Min. Negotiated Rate	$1,835.42
Max. Negotiated Rate	$6,118.07
Rate for Payer: Aetna Commercial	$3,670.84
Rate for Payer: Aetna Medicare Advantage	$3,670.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,120.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,120.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,447.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,120.22
Rate for Payer: Cigna Commercial	$6,118.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,961.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,835.42

PLATE TIBIA LF 2 HOLE 95MM

Facility

$12,236.15

Service Code	HCPCS C1713
Hospital Charge Code	270699118
Hospital Revenue Code	278
Min. Negotiated Rate	$1,835.42
Max. Negotiated Rate	$2,961.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,447.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,961.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,835.42

PLATE TIBIAL LCP 3.5 8HOLE LT

Facility

$7,464.00

Hospital Charge Code	270671109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.60
Max. Negotiated Rate	$1,806.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,492.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,806.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,119.60

PLATE TIBIAL LCP 3.5 8HOLE LT

Facility

$7,464.00

Hospital Charge Code	270671109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.60
Max. Negotiated Rate	$3,732.00
Rate for Payer: Aetna Commercial	$2,239.20
Rate for Payer: Aetna Medicare Advantage	$2,239.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,903.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,903.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,492.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,903.32
Rate for Payer: Cigna Commercial	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,806.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,119.60

PLATE TIBIAL PROX 6-HOLE

Facility

$10,020.00

Hospital Charge Code	270651345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.00
Max. Negotiated Rate	$2,424.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00

PLATE TIBIAL PROX 6-HOLE

Facility

$10,020.00

Hospital Charge Code	270651345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.00
Max. Negotiated Rate	$5,010.00
Rate for Payer: Aetna Commercial	$3,006.00
Rate for Payer: Aetna Medicare Advantage	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,555.10
Rate for Payer: Cigna Commercial	$5,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00

Know your out-of-pocket cost for care.

All Charges