Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEM COMP PS TRIATH PS RT SZ5

Facility

$10,774.30

Service Code	HCPCS C1776
Hospital Charge Code	270694176
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.14
Max. Negotiated Rate	$5,387.15
Rate for Payer: Aetna Commercial	$3,232.29
Rate for Payer: Aetna Medicare Advantage	$3,232.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.45
Rate for Payer: Cigna Commercial	$5,387.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.14

FEM COMP PS TRIATH PS RT SZ5

Facility

$10,774.30

Service Code	HCPCS C1776
Hospital Charge Code	270694176
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.14
Max. Negotiated Rate	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.14

FEM COMP TRIATHLON PS SZ3 RT

Facility

$11,109.45

Service Code	HCPCS C1776
Hospital Charge Code	270695255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,666.42
Max. Negotiated Rate	$5,554.73
Rate for Payer: Aetna Commercial	$3,332.84
Rate for Payer: Aetna Medicare Advantage	$3,332.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,832.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,832.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,221.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,832.91
Rate for Payer: Cigna Commercial	$5,554.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,688.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,666.42

FEM COMP TRIATHLON PS SZ3 RT

Facility

$11,109.45

Service Code	HCPCS C1776
Hospital Charge Code	270695255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,666.42
Max. Negotiated Rate	$2,688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,221.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,688.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,666.42

FEM CONSTRAINED 60 LT 145231

Facility

$23,460.85

Hospital Charge Code	270635589
Hospital Revenue Code	278
Min. Negotiated Rate	$3,519.13
Max. Negotiated Rate	$5,677.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,692.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,677.53
Rate for Payer: Qualcare PPO/HMO/WC	$3,519.13

FEM CONSTRAINED 60 LT 145231

Facility

$23,460.85

Hospital Charge Code	270635589
Hospital Revenue Code	278
Min. Negotiated Rate	$3,519.13
Max. Negotiated Rate	$11,730.42
Rate for Payer: Aetna Commercial	$7,038.26
Rate for Payer: Aetna Medicare Advantage	$7,038.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,692.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,982.52
Rate for Payer: Cigna Commercial	$11,730.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,677.53
Rate for Payer: Qualcare PPO/HMO/WC	$3,519.13

FEM DISTAL VANGUARD 65 X 5

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270692338
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$1,827.00
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

FEM DISTAL VANGUARD 65 X 5

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270692338
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

Femerol Head 28 medium

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677406
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Femerol Head 28 medium

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677406
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEM HD ARTIC 28MM 12/14 TAP

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270657701
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

FEM HD ARTIC 28MM 12/14 TAP

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270657701
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

FEM HD TYP1 TAPER 3MM NECK

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695267
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FEM HD TYP1 TAPER 3MM NECK

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695267
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FEM. HEAD 36MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703611
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

FEM. HEAD 36MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703611
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

FEM HEAD 36MM +8MMREF397164795

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703599
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

FEM HEAD 36MM +8MMREF397164795

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703599
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

FEM HEAD BALL EZE 28MM 12/14

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698951
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$787.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

FEM HEAD BALL EZE 28MM 12/14

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698951
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

FEM HEAD BIOLOX UNI TAPER SZ40

Facility

$4,686.15

Service Code	HCPCS C1776
Hospital Charge Code	270697194
Hospital Revenue Code	278
Min. Negotiated Rate	$702.92
Max. Negotiated Rate	$2,343.07
Rate for Payer: Aetna Commercial	$1,405.85
Rate for Payer: Aetna Medicare Advantage	$1,405.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,194.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,194.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,194.97
Rate for Payer: Cigna Commercial	$2,343.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,134.05
Rate for Payer: Qualcare PPO/HMO/WC	$702.92

FEM HEAD BIOLOX UNI TAPER SZ40

Facility

$4,686.15

Service Code	HCPCS C1776
Hospital Charge Code	270697194
Hospital Revenue Code	278
Min. Negotiated Rate	$702.92
Max. Negotiated Rate	$1,134.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,134.05
Rate for Payer: Qualcare PPO/HMO/WC	$702.92

FEM HEAD CERAM C-TPR 2.5X36MM

Facility

$4,799.25

Service Code	HCPCS C1776
Hospital Charge Code	270693125
Hospital Revenue Code	278
Min. Negotiated Rate	$719.89
Max. Negotiated Rate	$1,161.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.42
Rate for Payer: Qualcare PPO/HMO/WC	$719.89

FEM HEAD CERAM C-TPR 2.5X36MM

Facility

$4,799.25

Service Code	HCPCS C1776
Hospital Charge Code	270693125
Hospital Revenue Code	278
Min. Negotiated Rate	$719.89
Max. Negotiated Rate	$2,399.62
Rate for Payer: Aetna Commercial	$1,439.78
Rate for Payer: Aetna Medicare Advantage	$1,439.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,223.81
Rate for Payer: Cigna Commercial	$2,399.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.42
Rate for Payer: Qualcare PPO/HMO/WC	$719.89

FEM HEAD CER BIOLOX S TAP 28MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270694816
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$4,995.00
Rate for Payer: Aetna Commercial	$2,997.00
Rate for Payer: Aetna Medicare Advantage	$2,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,547.45
Rate for Payer: Cigna Commercial	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50

Know your out-of-pocket cost for care.

All Charges