Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688892
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688892
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

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688105
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

FEMORAL STEM 12/14 TPR SZ11

Facility

$6,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270700570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

FEMORAL STEM 12/14 TPR SZ11

Facility

$6,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270700570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,079.00
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

FEMORAL STEM (15)

Facility

$15,948.55

Hospital Charge Code	270657018
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

FEMORAL STEM (15)

Facility

$15,948.55

Hospital Charge Code	270657018
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$4,784.56
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

FEMORAL STEM ECHO 11X135MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691269
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 STEM ECHO 11X135MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691269
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- STEM FIBER METAL SZ13

Facility

$15,948.55

Hospital Charge Code	270657019
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$4,784.56
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

FEMORAL- STEM FIBER METAL SZ13

Facility

$15,948.55

Hospital Charge Code	270657019
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

FEMORAL STEM NOVA 12/14 SZ17

Facility

$12,998.00

Hospital Charge Code	270670574
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.70
Max. Negotiated Rate	$3,145.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.70

FEMORAL STEM NOVA 12/14 SZ17

Facility

$12,998.00

Hospital Charge Code	270670574
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.70
Max. Negotiated Rate	$6,499.00
Rate for Payer: Aetna Commercial	$3,899.40
Rate for Payer: Aetna Medicare Advantage	$3,899.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.49
Rate for Payer: Cigna Commercial	$6,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.70

FEMORAL STEM OFF POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672470
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 STEM OFF POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672470
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 STEM OFF POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672471
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 STEM OFF POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672471
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 STEM OFF POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672472
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 STEM OFF POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672472
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 STEM OFF POROUS SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672473
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 STEM OFF POROUS SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672473
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 STEM OFF POROUS SZ 6

Facility

$8,000.00

Hospital Charge Code	270672474
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 STEM OFF POROUS SZ 6

Facility

$8,000.00

Hospital Charge Code	270672474
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

Know your out-of-pocket cost for care.

All Charges