Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLATE UNIPLATE 1 LEVEL 14mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270684303
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 14MM

Facility

$5,625.00

Hospital Charge Code	270675230
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 14MM

Facility

$5,625.00

Hospital Charge Code	270675230
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 16MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270667380
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 16MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270667380
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 18MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270671111
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 18MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270671111
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 20mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270688180
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 20mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270688180
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 28mm

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270678718
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 28mm

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270678718
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 30MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270676523
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 30MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270676523
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 32MM

Facility

$5,875.00

Hospital Charge Code	270676850
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 32MM

Facility

$5,875.00

Hospital Charge Code	270676850
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 34MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270665073
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 34MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270665073
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 36MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270663103
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 36MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270663103
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE LEVEL 2 13MM

Facility

$5,625.00

Hospital Charge Code	270678225
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE LEVEL 2 13MM

Facility

$5,625.00

Hospital Charge Code	270678225
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIVERAL 8 HOLE

Facility

$8,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270690139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,212.75
Max. Negotiated Rate	$1,956.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75

PLATE UNIVERAL 8 HOLE

Facility

$8,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270690139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,212.75
Max. Negotiated Rate	$4,042.50
Rate for Payer: Aetna Commercial	$2,425.50
Rate for Payer: Aetna Medicare Advantage	$2,425.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,061.68
Rate for Payer: Cigna Commercial	$4,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75

PLATE UNIVERSAL

Facility

$5,305.00

Hospital Charge Code	270660697
Hospital Revenue Code	278
Min. Negotiated Rate	$795.75
Max. Negotiated Rate	$1,283.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,283.81
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

PLATE UNIVERSAL

Facility

$5,305.00

Hospital Charge Code	270660697
Hospital Revenue Code	278
Min. Negotiated Rate	$795.75
Max. Negotiated Rate	$2,652.50
Rate for Payer: Aetna Commercial	$1,591.50
Rate for Payer: Aetna Medicare Advantage	$1,591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,352.78
Rate for Payer: Cigna Commercial	$2,652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,283.81
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

Know your out-of-pocket cost for care.

All Charges