Heights University Hospital

All Charges

Charge

Type

Setting

Price

COMPONENT FEMORAL SZ 8 LM/RL

Facility

$12,100.00

Hospital Charge Code	270668670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.00
Max. Negotiated Rate	$2,928.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00

COMPONENT FEMORAL SZ 8 RM/LL

Facility

$12,100.00

Hospital Charge Code	270668678
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.00
Max. Negotiated Rate	$2,928.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00

COMPONENT FEMORAL SZ 8 RM/LL

Facility

$12,100.00

Hospital Charge Code	270668678
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Aetna Commercial	$3,630.00
Rate for Payer: Aetna Medicare Advantage	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,085.50
Rate for Payer: Cigna Commercial	$6,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00

COMPONENT FEM W/O HEAD 10MM

Facility

$15,645.00

Hospital Charge Code	270677207
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.75
Max. Negotiated Rate	$3,786.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,786.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.75

COMPONENT FEM W/O HEAD 10MM

Facility

$15,645.00

Hospital Charge Code	270677207
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.75
Max. Negotiated Rate	$7,822.50
Rate for Payer: Aetna Commercial	$4,693.50
Rate for Payer: Aetna Medicare Advantage	$4,693.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,989.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,989.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,989.47
Rate for Payer: Cigna Commercial	$7,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,786.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.75

COMPONENT MODULAR HEAD 28MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608171
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

COMPONENT MODULAR HEAD 28MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608171
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

COMPONENT TIBIA SZ 3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677840
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

COMPONENT TIBIA SZ 3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677840
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

COMPONENT TIBIA SZ 4 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677818
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

COMPONENT TIBIA SZ 4 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677818
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

COMPONENT TIBIA SZ 5 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677947
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

COMPONENT TIBIA SZ 5 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677947
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

COMPONENT TIBIA SZ 5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678417
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

COMPONENT TIBIA SZ 5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678417
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

COMPONENT TIBIA SZ 7 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677859
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

COMPONENT TIBIA SZ 7 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677859
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

COMPONENT TIBIA SZ 7 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677868
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

COMPONENT TIBIA SZ 7 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677868
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

COMPOSIX MESH 4X6

Facility

$688.00

Hospital Charge Code	270335677
Hospital Revenue Code	278
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

COMPOSIX MESH 4X6

Facility

$688.00

Hospital Charge Code	270335677
Hospital Revenue Code	278
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$344.00
Rate for Payer: Aetna Commercial	$206.40
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

COMPOUNDED IM INJ

Facility

$77.65

Hospital Charge Code	60628560
Hospital Revenue Code	250
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

COMPOUNDED IM INJ

Facility

$77.65

Hospital Charge Code	60628560
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$38.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$38.83

COMPOUNDED IM INJ

Facility

$62.10

Hospital Charge Code	60628597
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

COMPOUNDED IM INJ

Facility

$62.10

Hospital Charge Code	60628597
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

Know your out-of-pocket cost for care.

All Charges