Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL CEMENTED OPTETRAK SZ 5

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673670
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

FEMORAL CHECK POINT

Facility

$266.50

Service Code	HCPCS C1713
Hospital Charge Code	270690848
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$79.95
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

FEMORAL CHECK POINT

Facility

$266.50

Service Code	HCPCS C1713
Hospital Charge Code	270690848
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

FEMORAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668098
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$135.00

FEMORAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668098
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

FEMORAL COMP #3 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676673
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #3 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676673
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #3 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676623
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #3 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676623
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #5 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676725
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #5 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676725
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #5 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676751
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #5 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676751
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #6 RIGHT

Facility

$6,000.00

Hospital Charge Code	270677058
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #6 RIGHT

Facility

$6,000.00

Hospital Charge Code	270677058
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP CEMENTED #4 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676676
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP CEMENTED #4 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676676
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP EVOL CS CR SZ5 RT

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

FEMORAL COMP EVOL CS CR SZ5 RT

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$3,450.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

FEMORAL COMP LARGE 154602

Facility

$10,835.00

Hospital Charge Code	270638798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.25
Max. Negotiated Rate	$5,417.50
Rate for Payer: Aetna Commercial	$3,250.50
Rate for Payer: Aetna Medicare Advantage	$3,250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,762.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,762.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,762.93
Rate for Payer: Cigna Commercial	$5,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.25

FEMORAL COMP LARGE 154602

Facility

$10,835.00

Hospital Charge Code	270638798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.25
Max. Negotiated Rate	$2,622.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.25

FEMORAL COMP LAT 14x150MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270673645
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

FEMORAL COMP LAT 14x150MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270673645
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

FEMORAL COMPOMENT LEFT SZ 2

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMORAL COMPOMENT LEFT SZ 2

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

Know your out-of-pocket cost for care.

All Charges