Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL RPP NC ECHO POR

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692413
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 RPP NC ECHO POR

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692413
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 SOFT TISSUE FASTENER

Facility

$6,355.00

Service Code	HCPCS C1776
Hospital Charge Code	270679464
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$1,537.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

FEMORAL SOFT TISSUE FASTENER

Facility

$6,355.00

Service Code	HCPCS C1776
Hospital Charge Code	270679464
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$3,177.50
Rate for Payer: Aetna Commercial	$1,906.50
Rate for Payer: Aetna Medicare Advantage	$1,906.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.53
Rate for Payer: Cigna Commercial	$3,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

FEMORAL SPACER MOLD 60x42MM

Facility

$7,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270672077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.00
Max. Negotiated Rate	$1,931.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,596.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,197.00

FEMORAL SPACER MOLD 60x42MM

Facility

$7,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270672077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.00
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$2,394.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,034.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,034.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,596.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,034.90
Rate for Payer: Cigna Commercial	$3,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,197.00

FEMORAL SPHERE S3 INSTR SET

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684551
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMORAL SPHERE S3 INSTR SET

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684551
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMORAL SSK 65 LEFT

Facility

$28,175.00

Service Code	HCPCS C1776
Hospital Charge Code	270638755
Hospital Revenue Code	278
Min. Negotiated Rate	$4,226.25
Max. Negotiated Rate	$6,818.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,818.35
Rate for Payer: Qualcare PPO/HMO/WC	$4,226.25

FEMORAL SSK 65 LEFT

Facility

$28,175.00

Service Code	HCPCS C1776
Hospital Charge Code	270638755
Hospital Revenue Code	278
Min. Negotiated Rate	$4,226.25
Max. Negotiated Rate	$14,087.50
Rate for Payer: Aetna Commercial	$8,452.50
Rate for Payer: Aetna Medicare Advantage	$8,452.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,184.62
Rate for Payer: Cigna Commercial	$14,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,818.35
Rate for Payer: Qualcare PPO/HMO/WC	$4,226.25

FEMORAL SSK 65 RIGHT 183304

Facility

$34,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270647559
Hospital Revenue Code	278
Min. Negotiated Rate	$5,202.75
Max. Negotiated Rate	$17,342.50
Rate for Payer: Aetna Commercial	$10,405.50
Rate for Payer: Aetna Medicare Advantage	$10,405.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,937.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,844.67
Rate for Payer: Cigna Commercial	$17,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,393.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,202.75

FEMORAL SSK 65 RIGHT 183304

Facility

$34,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270647559
Hospital Revenue Code	278
Min. Negotiated Rate	$5,202.75
Max. Negotiated Rate	$8,393.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,937.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,393.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,202.75

FEMORAL SSK 70MM LEFT INTERLOK

Facility

$40,345.00

Hospital Charge Code	270671341
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$12,103.50
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 70MM LEFT INTERLOK

Facility

$40,345.00

Hospital Charge Code	270671341
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75mm RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270669900
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$12,103.50
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75mm RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270669900
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75MM RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270183308
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75MM RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270183308
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$12,103.50
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK RIGHT 50mm

Facility

$39,540.00

Hospital Charge Code	270675556
Hospital Revenue Code	278
Min. Negotiated Rate	$5,931.00
Max. Negotiated Rate	$19,770.00
Rate for Payer: Aetna Commercial	$11,862.00
Rate for Payer: Aetna Medicare Advantage	$11,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,082.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,082.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,908.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,082.70
Rate for Payer: Cigna Commercial	$19,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,568.68
Rate for Payer: Qualcare PPO/HMO/WC	$5,931.00

FEMORAL SSK RIGHT 50mm

Facility

$39,540.00

Hospital Charge Code	270675556
Hospital Revenue Code	278
Min. Negotiated Rate	$5,931.00
Max. Negotiated Rate	$9,568.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,908.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,568.68
Rate for Payer: Qualcare PPO/HMO/WC	$5,931.00

FEMORAL STEM 12/14 SZ 13 155MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678420
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 STEM 12/14 SZ 13 155MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678420
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 STEM 12/14 TAP CEMENT

Facility

$9,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270691682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$4,512.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,301.38
Rate for Payer: Cigna Commercial	$4,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

FEMORAL STEM 12/14 TAP CEMENT

Facility

$9,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270691682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

FEMORAL STEM 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270690555
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

Know your out-of-pocket cost for care.

All Charges