Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD 28MM MORSE TAPER +5 OFFSE

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682464
Hospital Revenue Code	278
Min. Negotiated Rate	$733.20
Max. Negotiated Rate	$1,182.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20

HEAD 28MM MORSE TAPER +5 OFFSE

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682464
Hospital Revenue Code	278
Min. Negotiated Rate	$733.20
Max. Negotiated Rate	$2,444.00
Rate for Payer: Aetna Commercial	$1,466.40
Rate for Payer: Aetna Medicare Advantage	$1,466.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.44
Rate for Payer: Cigna Commercial	$2,444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20

HEAD 32mm X +4

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677753
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

HEAD 32mm X +4

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677753
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

HEADACHES WITH MCC

Facility

$44,357.16

Service Code	MSDRG 102
Min. Negotiated Rate	$12,231.91
Max. Negotiated Rate	$44,357.16
Rate for Payer: Aetna Commercial	$37,796.60
Rate for Payer: Aetna Medicare Advantage	$12,231.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,356.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,356.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,785.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,356.07
Rate for Payer: Cigna Commercial	$24,122.89
Rate for Payer: Cigna Medicare Advantage	$14,785.72
Rate for Payer: Clover Medicare Advantage	$14,046.43
Rate for Payer: EmblemHealth Commercial	$44,357.16
Rate for Payer: Humana Medicare Advantage	$15,229.29
Rate for Payer: Oxford Commercial	$15,076.10
Rate for Payer: UnitedHealthcare Commercial	$17,112.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,785.72
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15,672.86
Rate for Payer: Wellcare Medicare Advantage	$14,785.72

HEADACHES WITHOUT MCC

Facility

$36,096.45

Service Code	MSDRG 103
Min. Negotiated Rate	$9,126.19
Max. Negotiated Rate	$36,096.45
Rate for Payer: Aetna Commercial	$28,199.93
Rate for Payer: Aetna Medicare Advantage	$9,126.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,156.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,156.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,032.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,156.28
Rate for Payer: Cigna Commercial	$17,998.01
Rate for Payer: Cigna Medicare Advantage	$12,032.15
Rate for Payer: Clover Medicare Advantage	$11,430.54
Rate for Payer: EmblemHealth Commercial	$36,096.45
Rate for Payer: Humana Medicare Advantage	$12,393.11
Rate for Payer: Oxford Commercial	$11,248.24
Rate for Payer: UnitedHealthcare Commercial	$12,767.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,032.15
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,754.08
Rate for Payer: Wellcare Medicare Advantage	$12,032.15

HEAD ANATOMIC 26MM LT

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693317
Hospital Revenue Code	278
Min. Negotiated Rate	$3,264.75
Max. Negotiated Rate	$5,267.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,353.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,267.13
Rate for Payer: Qualcare PPO/HMO/WC	$3,264.75

HEAD ANATOMIC 26MM LT

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693317
Hospital Revenue Code	278
Min. Negotiated Rate	$3,264.75
Max. Negotiated Rate	$10,882.50
Rate for Payer: Aetna Commercial	$6,529.50
Rate for Payer: Aetna Medicare Advantage	$6,529.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,550.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,550.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,353.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,550.07
Rate for Payer: Cigna Commercial	$10,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,267.13
Rate for Payer: Qualcare PPO/HMO/WC	$3,264.75

HEAD ANATOMIC RADIAL 7.0MM

Facility

$12,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270693290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.75
Max. Negotiated Rate	$2,943.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.75

HEAD ANATOMIC RADIAL 7.0MM

Facility

$12,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270693290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.75
Max. Negotiated Rate	$6,082.50
Rate for Payer: Aetna Commercial	$3,649.50
Rate for Payer: Aetna Medicare Advantage	$3,649.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.07
Rate for Payer: Cigna Commercial	$6,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.75

HEAD ARTICULATION 28mmI.D 50mm

Facility

$9,775.00

Hospital Charge Code	270645465
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

HEAD ARTICULATION 28mmI.D 50mm

Facility

$9,775.00

Hospital Charge Code	270645465
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$4,887.50
Rate for Payer: Aetna Commercial	$2,932.50
Rate for Payer: Aetna Medicare Advantage	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,492.62
Rate for Payer: Cigna Commercial	$4,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

HEAD BIOLOX DELTA FEM HEAD

Facility

$7,500.00

Hospital Charge Code	270663513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HEAD BIOLOX DELTA FEM HEAD

Facility

$7,500.00

Hospital Charge Code	270663513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HEAD BIOLOX DELTA OPT FEM 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$5,700.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$3,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,907.00
Rate for Payer: Cigna Commercial	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

HEAD BIOLOX DELTA OPT FEM 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$2,758.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

HEAD BIOMOD HUMAL 40X20 113762

Facility

$6,110.00

Hospital Charge Code	270341368
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

HEAD BIOMOD HUMAL 40X20 113762

Facility

$6,110.00

Hospital Charge Code	270341368
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$3,055.00
Rate for Payer: Aetna Commercial	$1,833.00
Rate for Payer: Aetna Medicare Advantage	$1,833.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,558.05
Rate for Payer: Cigna Commercial	$3,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

HEAD BIO-MODU HUM 40x20 113672

Facility

$6,110.00

Hospital Charge Code	270641368
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

HEAD BIO-MODU HUM 40x20 113672

Facility

$6,110.00

Hospital Charge Code	270641368
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$3,055.00
Rate for Payer: Aetna Commercial	$1,833.00
Rate for Payer: Aetna Medicare Advantage	$1,833.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,558.05
Rate for Payer: Cigna Commercial	$3,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

HEAD BIOMODULAR HUMERAL 54X24

Facility

$7,575.00

Hospital Charge Code	270649256
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.25
Max. Negotiated Rate	$3,787.50
Rate for Payer: Aetna Commercial	$2,272.50
Rate for Payer: Aetna Medicare Advantage	$2,272.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,931.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,931.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,931.62
Rate for Payer: Cigna Commercial	$3,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,833.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.25

HEAD BIOMODULAR HUMERAL 54X24

Facility

$7,575.00

Hospital Charge Code	270649256
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.25
Max. Negotiated Rate	$1,833.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,833.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.25

HEAD BI-POLAR

Facility

$6,325.00

Hospital Charge Code	270666932
Hospital Revenue Code	278
Min. Negotiated Rate	$948.75
Max. Negotiated Rate	$1,530.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$948.75

HEAD BI-POLAR

Facility

$6,325.00

Hospital Charge Code	270666932
Hospital Revenue Code	278
Min. Negotiated Rate	$948.75
Max. Negotiated Rate	$3,162.50
Rate for Payer: Aetna Commercial	$1,897.50
Rate for Payer: Aetna Medicare Advantage	$1,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,612.88
Rate for Payer: Cigna Commercial	$3,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$948.75

HEAD BIPOLAR 28x48MM

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677254
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

Know your out-of-pocket cost for care.

All Charges