Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689593
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689573
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689573
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689593
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 OD 28MM OFFST 8MM

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270695124
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$1,396.12
Rate for Payer: Aetna Commercial	$837.67
Rate for Payer: Aetna Medicare Advantage	$837.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$712.02
Rate for Payer: Cigna Commercial	$1,396.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: Qualcare PPO/HMO/WC	$418.84

FEMORAL HEAD OD 28MM OFFST 8MM

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270695124
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$675.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: Qualcare PPO/HMO/WC	$418.84

FEMORAL HEAD SMALL 28MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673193
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

FEMORAL HEAD SMALL 28MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673193
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 SZ 22MM +3.5MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675407
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

FEMORAL HEAD SZ 22MM +3.5MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675407
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 SZ28 +7 12/14 TAP

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675840
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 SZ28 +7 12/14 TAP

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675840
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

FEMORAL HEAD SZ 28MM +0MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672697
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

FEMORAL HEAD SZ 28MM +0MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672697
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,072.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

FEMORAL HEAD SZ D EXPLANT 38MM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270696896
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

FEMORAL HEAD SZ D EXPLANT 38MM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270696896
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

FEMORAL HEAD SZ M SZ 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688350
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 SZ M SZ 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688350
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

FEMORAL HEAD V40 -5MM 36MM

Facility

$3,575.00

Hospital Charge Code	270671314
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,072.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

FEMORAL HEAD V40 -5MM 36MM

Facility

$3,575.00

Hospital Charge Code	270671314
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

FEMORAL HEAD V40 COCR 28MM +12

Facility

$6,205.00

Service Code	HCPCS C1776
Hospital Charge Code	270676121
Hospital Revenue Code	278
Min. Negotiated Rate	$930.75
Max. Negotiated Rate	$1,501.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,501.61
Rate for Payer: Qualcare PPO/HMO/WC	$930.75

FEMORAL HEAD V40 COCR 28MM +12

Facility

$6,205.00

Service Code	HCPCS C1776
Hospital Charge Code	270676121
Hospital Revenue Code	278
Min. Negotiated Rate	$930.75
Max. Negotiated Rate	$3,102.50
Rate for Payer: Aetna Commercial	$1,861.50
Rate for Payer: Aetna Medicare Advantage	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,582.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,582.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,582.28
Rate for Payer: Cigna Commercial	$3,102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,501.61
Rate for Payer: Qualcare PPO/HMO/WC	$930.75

FEMORALHEMI CONDYLE RT LAT

Facility

$60,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672847
Hospital Revenue Code	278
Min. Negotiated Rate	$9,000.00
Max. Negotiated Rate	$30,000.00
Rate for Payer: Aetna Commercial	$18,000.00
Rate for Payer: Aetna Medicare Advantage	$18,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,300.00
Rate for Payer: Cigna Commercial	$30,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,000.00

FEMORALHEMI CONDYLE RT LAT

Facility

$60,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672847
Hospital Revenue Code	278
Min. Negotiated Rate	$9,000.00
Max. Negotiated Rate	$14,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,000.00

FEMORAL HIP ST R-NECK SZ10

Facility

$17,062.50

Service Code	HCPCS C1776
Hospital Charge Code	270692221
Hospital Revenue Code	278
Min. Negotiated Rate	$2,559.38
Max. Negotiated Rate	$8,531.25
Rate for Payer: Aetna Commercial	$5,118.75
Rate for Payer: Aetna Medicare Advantage	$5,118.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,350.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,350.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,350.94
Rate for Payer: Cigna Commercial	$8,531.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,129.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,559.38

Know your out-of-pocket cost for care.

All Charges