Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL COMPONANT SIZE 4

Facility

$7,500.00

Hospital Charge Code	270678341
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 COMPONANT SIZE 4

Facility

$7,500.00

Hospital Charge Code	270678341
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

FEMORAL COMPONANT SZ 5 LEFT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678755
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

FEMORAL COMPONANT SZ 5 LEFT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678755
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

FEMORAL COMPONENT

Facility

$17,435.00

Hospital Charge Code	270666803
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.25
Max. Negotiated Rate	$4,219.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.25

FEMORAL COMPONENT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL COMPONENT

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FEMORAL COMPONENT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL COMPONENT

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667709
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FEMORAL COMPONENT

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667709
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FEMORAL COMPONENT

Facility

$17,435.00

Hospital Charge Code	270666803
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.25
Max. Negotiated Rate	$8,717.50
Rate for Payer: Aetna Commercial	$5,230.50
Rate for Payer: Aetna Medicare Advantage	$5,230.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,445.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,445.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,445.93
Rate for Payer: Cigna Commercial	$8,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.25

FEMORAL COMPONENT

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FEMORAL COMPONENT 18MM

Facility

$20,376.00

Service Code	HCPCS C1776
Hospital Charge Code	270672590
Hospital Revenue Code	278
Min. Negotiated Rate	$3,056.40
Max. Negotiated Rate	$10,188.00
Rate for Payer: Aetna Commercial	$6,112.80
Rate for Payer: Aetna Medicare Advantage	$6,112.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,195.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,195.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,075.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,195.88
Rate for Payer: Cigna Commercial	$10,188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,930.99
Rate for Payer: Qualcare PPO/HMO/WC	$3,056.40

FEMORAL COMPONENT 18MM

Facility

$20,376.00

Service Code	HCPCS C1776
Hospital Charge Code	270672590
Hospital Revenue Code	278
Min. Negotiated Rate	$3,056.40
Max. Negotiated Rate	$4,930.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,075.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,930.99
Rate for Payer: Qualcare PPO/HMO/WC	$3,056.40

FEMORAL COMPONENT 54mm 102121

Facility

$9,042.45

Hospital Charge Code	270631519
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.37
Max. Negotiated Rate	$4,521.23
Rate for Payer: Aetna Commercial	$2,712.74
Rate for Payer: Aetna Medicare Advantage	$2,712.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,305.82
Rate for Payer: Cigna Commercial	$4,521.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37

FEMORAL COMPONENT 54mm 102121

Facility

$9,042.45

Hospital Charge Code	270631519
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.37
Max. Negotiated Rate	$2,188.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37

FEMORAL COMPONENT 74MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676065
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

FEMORAL COMPONENT 74MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676065
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

FEMORAL COMPONENT CEMENTED SZ

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687756
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL COMPONENT CEMENTED SZ

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687756
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL COMPONENT CEMENT TRI

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270692000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,171.37
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

FEMORAL COMPONENT CEMENT TRI

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270692000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

FEMORAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686975
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

FEMORAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686975
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

FEMORAL COMPONENT PS LEFT 4N

Facility

$12,000.00

Hospital Charge Code	270676520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

Know your out-of-pocket cost for care.

All Charges