Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEM BIOLOX DELTA CER 28MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270694799
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,417.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50

HEADFEMBIOLOXDLT12/14TAP36MM

Facility

$8,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270697655
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.25
Max. Negotiated Rate	$2,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25

HEADFEMBIOLOXDLT12/14TAP36MM

Facility

$8,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270697655
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.25
Max. Negotiated Rate	$4,217.50
Rate for Payer: Aetna Commercial	$2,530.50
Rate for Payer: Aetna Medicare Advantage	$2,530.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,150.93
Rate for Payer: Cigna Commercial	$4,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25

HEAD FEM CER BIOLOX DELTA 36MM

Facility

$17,434.35

Service Code	HCPCS C1776
Hospital Charge Code	270698838
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.15
Max. Negotiated Rate	$4,219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.15

HEAD FEM CER BIOLOX DELTA 36MM

Facility

$17,434.35

Service Code	HCPCS C1776
Hospital Charge Code	270698838
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.15
Max. Negotiated Rate	$8,717.17
Rate for Payer: Aetna Commercial	$5,230.31
Rate for Payer: Aetna Medicare Advantage	$5,230.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,445.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,445.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,445.76
Rate for Payer: Cigna Commercial	$8,717.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.15

HEAD FEM DELTA BIOLOX 28MM

Facility

$6,410.00

Service Code	HCPCS C1776
Hospital Charge Code	270700045
Hospital Revenue Code	278
Min. Negotiated Rate	$961.50
Max. Negotiated Rate	$1,551.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.22
Rate for Payer: Qualcare PPO/HMO/WC	$961.50

HEAD FEM DELTA BIOLOX 28MM

Facility

$6,410.00

Service Code	HCPCS C1776
Hospital Charge Code	270700045
Hospital Revenue Code	278
Min. Negotiated Rate	$961.50
Max. Negotiated Rate	$3,205.00
Rate for Payer: Aetna Commercial	$1,923.00
Rate for Payer: Aetna Medicare Advantage	$1,923.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,634.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,634.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,634.55
Rate for Payer: Cigna Commercial	$3,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.22
Rate for Payer: Qualcare PPO/HMO/WC	$961.50

HEAD FEMORAL 26MM +8MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270673427
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,072.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

HEAD FEMORAL 26MM +8MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270673427
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

HEAD FEMORAL 28mm +0mm

Facility

$4,271.30

Service Code	HCPCS C1776
Hospital Charge Code	270676689
Hospital Revenue Code	278
Min. Negotiated Rate	$640.70
Max. Negotiated Rate	$2,135.65
Rate for Payer: Aetna Commercial	$1,281.39
Rate for Payer: Aetna Medicare Advantage	$1,281.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,089.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,089.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,089.18
Rate for Payer: Cigna Commercial	$2,135.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.65
Rate for Payer: Qualcare PPO/HMO/WC	$640.70

HEAD FEMORAL 28mm +0mm

Facility

$4,271.30

Service Code	HCPCS C1776
Hospital Charge Code	270676689
Hospital Revenue Code	278
Min. Negotiated Rate	$640.70
Max. Negotiated Rate	$1,033.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.65
Rate for Payer: Qualcare PPO/HMO/WC	$640.70

HEAD FEMORAL 28MM +5

Facility

$2,610.00

Hospital Charge Code	270677210
Hospital Revenue Code	278
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$631.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$522.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.62
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD FEMORAL 28MM +5

Facility

$2,610.00

Hospital Charge Code	270677210
Hospital Revenue Code	278
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$522.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.62
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD FEMORAL 28MM LARGE

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677987
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 FEMORAL 28MM LARGE

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677987
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 FEMORAL 28MM LONG 9026-30

Facility

$2,120.85

Hospital Charge Code	270614531
Hospital Revenue Code	278
Min. Negotiated Rate	$318.13
Max. Negotiated Rate	$1,060.42
Rate for Payer: Aetna Commercial	$636.25
Rate for Payer: Aetna Medicare Advantage	$636.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$424.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.82
Rate for Payer: Cigna Commercial	$1,060.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.13

HEAD FEMORAL 28MM LONG 9026-30

Facility

$2,120.85

Hospital Charge Code	270614531
Hospital Revenue Code	278
Min. Negotiated Rate	$318.13
Max. Negotiated Rate	$513.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$424.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.13

HEAD FEMORAL 28MMOD 4MM LNGTH

Facility

$8,662.50

Service Code	HCPCS C1776
Hospital Charge Code	270646339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.38
Max. Negotiated Rate	$2,096.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,096.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.38

HEAD FEMORAL 28MMOD 4MM LNGTH

Facility

$8,662.50

Service Code	HCPCS C1776
Hospital Charge Code	270646339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.38
Max. Negotiated Rate	$4,331.25
Rate for Payer: Aetna Commercial	$2,598.75
Rate for Payer: Aetna Medicare Advantage	$2,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.94
Rate for Payer: Cigna Commercial	$4,331.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,096.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.38

HEAD FEMORAL 32MM +0MM

Facility

$4,143.00

Service Code	HCPCS C1776
Hospital Charge Code	270680957
Hospital Revenue Code	278
Min. Negotiated Rate	$621.45
Max. Negotiated Rate	$1,002.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$828.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,002.61
Rate for Payer: Qualcare PPO/HMO/WC	$621.45

HEAD FEMORAL 32MM +0MM

Facility

$4,143.00

Service Code	HCPCS C1776
Hospital Charge Code	270680957
Hospital Revenue Code	278
Min. Negotiated Rate	$621.45
Max. Negotiated Rate	$2,071.50
Rate for Payer: Aetna Commercial	$1,242.90
Rate for Payer: Aetna Medicare Advantage	$1,242.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,056.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,056.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$828.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,056.46
Rate for Payer: Cigna Commercial	$2,071.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,002.61
Rate for Payer: Qualcare PPO/HMO/WC	$621.45

HEAD FEMORAL 32mmDIA +3mm NECK

Facility

$4,065.00

Hospital Charge Code	270642681
Hospital Revenue Code	278
Min. Negotiated Rate	$609.75
Max. Negotiated Rate	$983.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$813.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.73
Rate for Payer: Qualcare PPO/HMO/WC	$609.75

HEAD FEMORAL 32mmDIA +3mm NECK

Facility

$4,065.00

Hospital Charge Code	270642681
Hospital Revenue Code	278
Min. Negotiated Rate	$609.75
Max. Negotiated Rate	$2,032.50
Rate for Payer: Aetna Commercial	$1,219.50
Rate for Payer: Aetna Medicare Advantage	$1,219.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,036.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,036.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$813.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,036.58
Rate for Payer: Cigna Commercial	$2,032.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.73
Rate for Payer: Qualcare PPO/HMO/WC	$609.75

HEAD FEMORAL 36-50mm

Facility

$9,044.75

Service Code	HCPCS C1776
Hospital Charge Code	270678864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.71
Max. Negotiated Rate	$2,188.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.71

HEAD FEMORAL 36-50mm

Facility

$9,044.75

Service Code	HCPCS C1776
Hospital Charge Code	270678864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.71
Max. Negotiated Rate	$4,522.38
Rate for Payer: Aetna Commercial	$2,713.43
Rate for Payer: Aetna Medicare Advantage	$2,713.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,306.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,306.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,306.41
Rate for Payer: Cigna Commercial	$4,522.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.71

Know your out-of-pocket cost for care.

All Charges