Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMRL FPP NC ECHO POR 12X 40MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691841
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

FEMRL PS 57.5 LEFT OPEN 183122

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270650855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

FEMRL PS 57.5 LEFT OPEN 183122

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270650855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$3,300.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

FEM ST 12X14 TAPR WPORCOATSZ2

Facility

$9,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270691333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,455.00
Max. Negotiated Rate	$2,347.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.00

FEM ST 12X14 TAPR WPORCOATSZ2

Facility

$9,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270691333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,455.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Aetna Commercial	$2,910.00
Rate for Payer: Aetna Medicare Advantage	$2,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,473.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,473.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,940.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,473.50
Rate for Payer: Cigna Commercial	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.00

FEM STABLIZER RT TRIATH SZ2

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270693302
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

FEM STABLIZER RT TRIATH SZ2

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270693302
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

FEMSTAT 2%/28GM

Facility

$101.00

Hospital Charge Code	60632971
Hospital Revenue Code	250
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$50.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$50.50

FEMSTAT 2%/28GM

Facility

$101.00

Hospital Charge Code	60632971
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

FEM STEM 12/14 TAP SZ2 STD97MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695674
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

FEM STEM 12/14 TAP SZ2 STD97MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695674
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

FEM STEM 132D SZ6 35MM 111MM

Facility

$13,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270695130
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$3,291.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,291.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.00

FEM STEM 132D SZ6 35MM 111MM

Facility

$13,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270695130
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$6,800.00
Rate for Payer: Aetna Commercial	$4,080.00
Rate for Payer: Aetna Medicare Advantage	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,468.00
Rate for Payer: Cigna Commercial	$6,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,291.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.00

FEM STEM STD 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270696051
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.88
Max. Negotiated Rate	$4,856.25
Rate for Payer: Aetna Commercial	$2,913.75
Rate for Payer: Aetna Medicare Advantage	$2,913.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,476.69
Rate for Payer: Cigna Commercial	$4,856.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88

FEM STEM STD 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270696051
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.88
Max. Negotiated Rate	$2,350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88

FEM TOTAL COMP STAB TRIATHLON

Facility

$65,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270691989
Hospital Revenue Code	278
Min. Negotiated Rate	$9,815.25
Max. Negotiated Rate	$32,717.50
Rate for Payer: Aetna Commercial	$19,630.50
Rate for Payer: Aetna Medicare Advantage	$19,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,685.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,685.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,685.92
Rate for Payer: Cigna Commercial	$32,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,835.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,815.25

FEM TOTAL COMP STAB TRIATHLON

Facility

$65,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270691989
Hospital Revenue Code	278
Min. Negotiated Rate	$9,815.25
Max. Negotiated Rate	$15,835.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,835.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,815.25

FEM TPR LC 133 T1 HO 13X146MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695266
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

FEM TPR LC 133 T1 HO 13X146MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695266
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

FEMUR

Facility

$11,724.30

Hospital Charge Code	270657022
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.64
Max. Negotiated Rate	$2,837.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.64

FEMUR

Facility

$11,724.30

Hospital Charge Code	270657022
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.64
Max. Negotiated Rate	$5,862.15
Rate for Payer: Aetna Commercial	$3,517.29
Rate for Payer: Aetna Medicare Advantage	$3,517.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,989.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,989.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,989.70
Rate for Payer: Cigna Commercial	$5,862.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.64

FEMUR 1 VIEW BILAT

Facility

$358.23

Service Code	HCPCS 7355150
Hospital Charge Code	94061483
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR 1 VIEW BILAT

Facility

$358.23

Service Code	HCPCS 7355150
Hospital Charge Code	94270264
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR 1 VIEW BILAT

Facility

$358.23

Service Code	HCPCS 7355150
Hospital Charge Code	75190639
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR 1 VIEW BILAT

Facility

$358.23

Service Code	HCPCS 7355150
Hospital Charge Code	75190639
Hospital Revenue Code	320
Min. Negotiated Rate	$46.57
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$107.47
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges