Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD BMT MALL 9 220 11-104958

Facility

$22,080.00

Hospital Charge Code	270611648
Hospital Revenue Code	278
Min. Negotiated Rate	$3,312.00
Max. Negotiated Rate	$5,343.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,343.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.00

HEAD BMT MOD 139028

Facility

$2,616.85

Hospital Charge Code	270608617
Hospital Revenue Code	278
Min. Negotiated Rate	$392.53
Max. Negotiated Rate	$1,308.42
Rate for Payer: Aetna Commercial	$785.05
Rate for Payer: Aetna Medicare Advantage	$785.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$667.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$667.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$667.30
Rate for Payer: Cigna Commercial	$1,308.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$633.28
Rate for Payer: Qualcare PPO/HMO/WC	$392.53

HEAD BMT MOD 139028

Facility

$2,616.85

Hospital Charge Code	270608617
Hospital Revenue Code	278
Min. Negotiated Rate	$392.53
Max. Negotiated Rate	$633.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$633.28
Rate for Payer: Qualcare PPO/HMO/WC	$392.53

HEAD BMT MOD 28 6 163660

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270607276
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 BMT MOD 28 6 163660

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270607276
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

HEAD BMT MOD COMP 28 163662

Facility

$2,967.25

Hospital Charge Code	270622512
Hospital Revenue Code	278
Min. Negotiated Rate	$445.09
Max. Negotiated Rate	$718.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$593.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.07
Rate for Payer: Qualcare PPO/HMO/WC	$445.09

HEAD BMT MOD COMP 28 163662

Facility

$2,967.25

Hospital Charge Code	270622512
Hospital Revenue Code	278
Min. Negotiated Rate	$445.09
Max. Negotiated Rate	$1,483.62
Rate for Payer: Aetna Commercial	$890.17
Rate for Payer: Aetna Medicare Advantage	$890.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$756.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$756.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$593.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$756.65
Rate for Payer: Cigna Commercial	$1,483.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.07
Rate for Payer: Qualcare PPO/HMO/WC	$445.09

HEAD BMT MOD HMRL 44 113766

Facility

$4,125.65

Hospital Charge Code	270609677
Hospital Revenue Code	278
Min. Negotiated Rate	$618.85
Max. Negotiated Rate	$2,062.82
Rate for Payer: Aetna Commercial	$1,237.69
Rate for Payer: Aetna Medicare Advantage	$1,237.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.04
Rate for Payer: Cigna Commercial	$2,062.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.41
Rate for Payer: Qualcare PPO/HMO/WC	$618.85

HEAD BMT MOD HMRL 44 113766

Facility

$4,125.65

Hospital Charge Code	270609677
Hospital Revenue Code	278
Min. Negotiated Rate	$618.85
Max. Negotiated Rate	$998.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.41
Rate for Payer: Qualcare PPO/HMO/WC	$618.85

HEAD BMT MOD HMRL 44 15 113763

Facility

$4,667.25

Hospital Charge Code	270619987
Hospital Revenue Code	278
Min. Negotiated Rate	$700.09
Max. Negotiated Rate	$1,129.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$933.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.47
Rate for Payer: Qualcare PPO/HMO/WC	$700.09

HEAD BMT MOD HMRL 44 15 113763

Facility

$4,667.25

Hospital Charge Code	270619987
Hospital Revenue Code	278
Min. Negotiated Rate	$700.09
Max. Negotiated Rate	$2,333.62
Rate for Payer: Aetna Commercial	$1,400.17
Rate for Payer: Aetna Medicare Advantage	$1,400.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,190.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,190.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$933.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,190.15
Rate for Payer: Cigna Commercial	$2,333.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.47
Rate for Payer: Qualcare PPO/HMO/WC	$700.09

HEAD BMT MOD HMRL 44 17 113764

Facility

$6,110.00

Hospital Charge Code	270620916
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 BMT MOD HMRL 44 17 113764

Facility

$6,110.00

Hospital Charge Code	270620916
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 BMT STD NECK 38 173662

Facility

$5,200.00

Hospital Charge Code	270628617
Hospital Revenue Code	278
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$1,258.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.40
Rate for Payer: Qualcare PPO/HMO/WC	$780.00

HEAD BMT STD NECK 38 173662

Facility

$5,200.00

Hospital Charge Code	270628617
Hospital Revenue Code	278
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$2,600.00
Rate for Payer: Aetna Commercial	$1,560.00
Rate for Payer: Aetna Medicare Advantage	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,326.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,326.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,326.00
Rate for Payer: Cigna Commercial	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.40
Rate for Payer: Qualcare PPO/HMO/WC	$780.00

HEAD CERAMIC 28mm TYPE 16/18

Facility

$6,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270645466
Hospital Revenue Code	278
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$3,155.00
Rate for Payer: Aetna Commercial	$1,893.00
Rate for Payer: Aetna Medicare Advantage	$1,893.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,609.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,609.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,609.05
Rate for Payer: Cigna Commercial	$3,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,527.02
Rate for Payer: Qualcare PPO/HMO/WC	$946.50

HEAD CERAMIC 28mm TYPE 16/18

Facility

$6,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270645466
Hospital Revenue Code	278
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$1,527.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,527.02
Rate for Payer: Qualcare PPO/HMO/WC	$946.50

HEAD CERC 40 16/18 TAP 6501058

Facility

$11,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270644874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,656.00
Max. Negotiated Rate	$2,671.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,656.00

HEAD CERC 40 16/18 TAP 6501058

Facility

$11,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270644874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,656.00
Max. Negotiated Rate	$5,520.00
Rate for Payer: Aetna Commercial	$3,312.00
Rate for Payer: Aetna Medicare Advantage	$3,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,815.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,815.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,208.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,815.20
Rate for Payer: Cigna Commercial	$5,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,656.00

HEAD COCR M 36M

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681920
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

HEAD COCR M 36M

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681920
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

HEAD COMP ENDOPROSTHESIS 42MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270674000
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,237.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

HEAD COMP ENDOPROSTHESIS 42MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270674000
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

HEAD COMP ENDOPROSTHESIS 43MM

Facility

$4,252.25

Service Code	HCPCS C1776
Hospital Charge Code	270678036
Hospital Revenue Code	278
Min. Negotiated Rate	$637.84
Max. Negotiated Rate	$2,126.12
Rate for Payer: Aetna Commercial	$1,275.67
Rate for Payer: Aetna Medicare Advantage	$1,275.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.32
Rate for Payer: Cigna Commercial	$2,126.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.04
Rate for Payer: Qualcare PPO/HMO/WC	$637.84

HEAD COMP ENDOPROSTHESIS 43MM

Facility

$4,252.25

Service Code	HCPCS C1776
Hospital Charge Code	270678036
Hospital Revenue Code	278
Min. Negotiated Rate	$637.84
Max. Negotiated Rate	$1,029.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.04
Rate for Payer: Qualcare PPO/HMO/WC	$637.84

Know your out-of-pocket cost for care.

All Charges