Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL CRUCIATE RT CR SZ3

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	693337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

FEMORAL CRUCIATE SZ 5

Facility

$7,846.70

Service Code	HCPCS C1776
Hospital Charge Code	270691406
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.01
Max. Negotiated Rate	$3,923.35
Rate for Payer: Aetna Commercial	$2,354.01
Rate for Payer: Aetna Medicare Advantage	$2,354.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.91
Rate for Payer: Cigna Commercial	$3,923.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.01

FEMORAL CRUCIATE SZ 5

Facility

$7,846.70

Service Code	HCPCS C1776
Hospital Charge Code	270691406
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.01
Max. Negotiated Rate	$1,898.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.01

FEMORAL DISTAL AUG #3 12MM

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687696
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$1,821.00
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

FEMORAL DISTAL AUG #3 12MM

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687696
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$1,468.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

FEMORAL DISTAL BLK SCW SZ4 5MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270670654
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,158.30
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

FEMORAL DISTAL BLK SCW SZ4 5MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270670654
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

FEMORAL DISTAL SZ3 5MM SRW BLK

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668742
Hospital Revenue Code	278
Min. Negotiated Rate	$816.75
Max. Negotiated Rate	$1,317.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: Qualcare PPO/HMO/WC	$816.75

FEMORAL DISTAL SZ3 5MM SRW BLK

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668742
Hospital Revenue Code	278
Min. Negotiated Rate	$816.75
Max. Negotiated Rate	$2,722.50
Rate for Payer: Aetna Commercial	$1,633.50
Rate for Payer: Aetna Medicare Advantage	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,388.47
Rate for Payer: Cigna Commercial	$2,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: Qualcare PPO/HMO/WC	$816.75

FEMORAL DIS TRAY CONTOUR LOCK

Facility

$2,475.00

Hospital Charge Code	270675926
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.75
Rate for Payer: Oxford Commercial	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$1,237.50

FEMORAL DIS TRAY CONTOUR LOCK

Facility

$2,475.00

Hospital Charge Code	270675926
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

FEMORAL ECHO POR RPP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690589
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

FEMORAL ECHO POR RPP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690589
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

FEMORAL GMK CEMENTED SZ5 RIGH

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678629
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 GMK CEMENTED SZ5 RIGH

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678629
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Aetna Commercial	$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 HD BIPOLAR UNI 26X41MM

Facility

$2,743.55

Service Code	HCPCS C1776
Hospital Charge Code	270695308
Hospital Revenue Code	278
Min. Negotiated Rate	$411.53
Max. Negotiated Rate	$1,371.78
Rate for Payer: Aetna Commercial	$823.07
Rate for Payer: Aetna Medicare Advantage	$823.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.61
Rate for Payer: Cigna Commercial	$1,371.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.94
Rate for Payer: Qualcare PPO/HMO/WC	$411.53

FEMORAL HD BIPOLAR UNI 26X41MM

Facility

$2,743.55

Service Code	HCPCS C1776
Hospital Charge Code	270695308
Hospital Revenue Code	278
Min. Negotiated Rate	$411.53
Max. Negotiated Rate	$663.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.94
Rate for Payer: Qualcare PPO/HMO/WC	$411.53

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657012
Hospital Revenue Code	278
Min. Negotiated Rate	$408.29
Max. Negotiated Rate	$1,360.95
Rate for Payer: Aetna Commercial	$816.57
Rate for Payer: Aetna Medicare Advantage	$816.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.08
Rate for Payer: Cigna Commercial	$1,360.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: Qualcare PPO/HMO/WC	$408.29

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657012
Hospital Revenue Code	278
Min. Negotiated Rate	$408.29
Max. Negotiated Rate	$658.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: Qualcare PPO/HMO/WC	$408.29

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657014
Hospital Revenue Code	278
Min. Negotiated Rate	$408.29
Max. Negotiated Rate	$1,360.95
Rate for Payer: Aetna Commercial	$816.57
Rate for Payer: Aetna Medicare Advantage	$816.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.08
Rate for Payer: Cigna Commercial	$1,360.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: Qualcare PPO/HMO/WC	$408.29

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657014
Hospital Revenue Code	278
Min. Negotiated Rate	$408.29
Max. Negotiated Rate	$658.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: Qualcare PPO/HMO/WC	$408.29

FEMORAL HEAD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686378
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

FEMORAL HEAD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686378
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

FEMORAL HEAD 12/14 TAPER +0MM

Facility

$2,000.00

Hospital Charge Code	270676225
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

FEMORAL HEAD 12/14 TAPER +0MM

Facility

$2,000.00

Hospital Charge Code	270676225
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

Know your out-of-pocket cost for care.

All Charges