Heights University Hospital

All Charges

Charge

Type

Setting

Price

CUP TRILOCK HIP 58MM SP

Facility

$4,750.00

Hospital Charge Code	270655478
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CUP TRILOCK HIP 58MM SP

Facility

$4,750.00

Hospital Charge Code	270655478
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CUP & TUBING MITIVAC

Facility

$215.25

Hospital Charge Code	270600591
Hospital Revenue Code	272
Min. Negotiated Rate	$27.98
Max. Negotiated Rate	$107.62
Rate for Payer: Aetna Commercial	$64.58
Rate for Payer: Aetna Medicare Advantage	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.89
Rate for Payer: Cigna Commercial	$107.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.98
Rate for Payer: Oxford Commercial	$107.62
Rate for Payer: Qualcare PPO/HMO/WC	$32.29
Rate for Payer: UnitedHealthcare Commercial	$107.62

CUP & TUBING MITIVAC

Facility

$215.25

Hospital Charge Code	270600591
Hospital Revenue Code	272
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Qualcare PPO/HMO/WC	$32.29

CUP VACUUM ASSIST DELIVERY

Facility

$146.56

Hospital Charge Code	270659920
Hospital Revenue Code	272
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$73.28
Rate for Payer: Aetna Commercial	$43.97
Rate for Payer: Aetna Medicare Advantage	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.37
Rate for Payer: Cigna Commercial	$73.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.05
Rate for Payer: Oxford Commercial	$73.28
Rate for Payer: Qualcare PPO/HMO/WC	$21.98
Rate for Payer: UnitedHealthcare Commercial	$73.28

CUP VACUUM ASSIST DELIVERY

Facility

$146.56

Hospital Charge Code	270659920
Hospital Revenue Code	272
Min. Negotiated Rate	$21.98
Max. Negotiated Rate	$21.98
Rate for Payer: Qualcare PPO/HMO/WC	$21.98

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685212
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685212
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677886
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677886
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677708
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677708
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 52MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669777
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 52MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669777
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 54MM

Facility

$1,987.85

Service Code	HCPCS C1776
Hospital Charge Code	270680131
Hospital Revenue Code	278
Min. Negotiated Rate	$298.18
Max. Negotiated Rate	$481.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$397.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.06
Rate for Payer: Qualcare PPO/HMO/WC	$298.18

CUP VERSAFIT 54MM

Facility

$1,987.85

Service Code	HCPCS C1776
Hospital Charge Code	270680131
Hospital Revenue Code	278
Min. Negotiated Rate	$298.18
Max. Negotiated Rate	$993.92
Rate for Payer: Aetna Commercial	$596.36
Rate for Payer: Aetna Medicare Advantage	$596.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$397.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.90
Rate for Payer: Cigna Commercial	$993.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.06
Rate for Payer: Qualcare PPO/HMO/WC	$298.18

CUP VERSAFIT 60MM

Facility

$16,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668031
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CUP VERSAFIT 60MM

Facility

$16,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668031
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CUP VERSAFIT 62MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682090
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 62MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682090
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 64MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681947
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 64MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681947
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFITCUP 46MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684248
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

Know your out-of-pocket cost for care.

All Charges