Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMORAL 36MM

Facility

$8,498.00

Service Code	HCPCS C1776
Hospital Charge Code	270678672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.70
Max. Negotiated Rate	$4,249.00
Rate for Payer: Aetna Commercial	$2,549.40
Rate for Payer: Aetna Medicare Advantage	$2,549.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.99
Rate for Payer: Cigna Commercial	$4,249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,056.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.70

HEAD FEMORAL 36MM

Facility

$4,250.00

Hospital Charge Code	270703305
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

HEAD FEMORAL 36MM

Facility

$4,250.00

Hospital Charge Code	270703305
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

HEAD FEMORAL 36MM

Facility

$8,498.00

Service Code	HCPCS C1776
Hospital Charge Code	270678672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.70
Max. Negotiated Rate	$2,056.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,056.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.70

HEAD FEMORAL 36MM +0MM

Facility

$4,087.15

Service Code	HCPCS C1776
Hospital Charge Code	270679973
Hospital Revenue Code	278
Min. Negotiated Rate	$613.07
Max. Negotiated Rate	$989.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.09
Rate for Payer: Qualcare PPO/HMO/WC	$613.07

HEAD FEMORAL 36MM +0MM

Facility

$4,087.15

Service Code	HCPCS C1776
Hospital Charge Code	270679973
Hospital Revenue Code	278
Min. Negotiated Rate	$613.07
Max. Negotiated Rate	$2,043.58
Rate for Payer: Aetna Commercial	$1,226.14
Rate for Payer: Aetna Medicare Advantage	$1,226.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.22
Rate for Payer: Cigna Commercial	$2,043.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.09
Rate for Payer: Qualcare PPO/HMO/WC	$613.07

HEAD FEMORAL 36MM -2.5MM

Facility

$4,728.50

Service Code	HCPCS C1776
Hospital Charge Code	270676583
Hospital Revenue Code	278
Min. Negotiated Rate	$709.27
Max. Negotiated Rate	$2,364.25
Rate for Payer: Aetna Commercial	$1,418.55
Rate for Payer: Aetna Medicare Advantage	$1,418.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,205.77
Rate for Payer: Cigna Commercial	$2,364.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.30
Rate for Payer: Qualcare PPO/HMO/WC	$709.27

HEAD FEMORAL 36MM -2.5MM

Facility

$4,728.50

Service Code	HCPCS C1776
Hospital Charge Code	270676583
Hospital Revenue Code	278
Min. Negotiated Rate	$709.27
Max. Negotiated Rate	$1,144.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.30
Rate for Payer: Qualcare PPO/HMO/WC	$709.27

HEAD FEMORAL 36MM +5MM

Facility

$4,182.30

Service Code	HCPCS C1776
Hospital Charge Code	270677486
Hospital Revenue Code	278
Min. Negotiated Rate	$627.35
Max. Negotiated Rate	$2,091.15
Rate for Payer: Aetna Commercial	$1,254.69
Rate for Payer: Aetna Medicare Advantage	$1,254.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,066.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,066.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,066.49
Rate for Payer: Cigna Commercial	$2,091.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.12
Rate for Payer: Qualcare PPO/HMO/WC	$627.35

HEAD FEMORAL 36MM +5MM

Facility

$4,182.30

Service Code	HCPCS C1776
Hospital Charge Code	270677486
Hospital Revenue Code	278
Min. Negotiated Rate	$627.35
Max. Negotiated Rate	$1,012.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.12
Rate for Payer: Qualcare PPO/HMO/WC	$627.35

HEAD FEMORAL 3x28MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677118
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

HEAD FEMORAL 3x28MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677118
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

HEAD FEMORAL 8018-28-14

Facility

$3,239.60

Hospital Charge Code	270638803
Hospital Revenue Code	278
Min. Negotiated Rate	$485.94
Max. Negotiated Rate	$1,619.80
Rate for Payer: Aetna Commercial	$971.88
Rate for Payer: Aetna Medicare Advantage	$971.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$647.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.10
Rate for Payer: Cigna Commercial	$1,619.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.98
Rate for Payer: Qualcare PPO/HMO/WC	$485.94

HEAD FEMORAL 8018-28-14

Facility

$3,239.60

Hospital Charge Code	270638803
Hospital Revenue Code	278
Min. Negotiated Rate	$485.94
Max. Negotiated Rate	$783.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$647.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.98
Rate for Payer: Qualcare PPO/HMO/WC	$485.94

HEAD FEMORAL ALLOGRAFT 77-0038

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270627380
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

HEAD FEMORAL ALLOGRAFT 77-0038

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270627380
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

HEAD FEMORAL CERAM BIOLOX 36MM

Facility

$10,220.00

Service Code	HCPCS C1776
Hospital Charge Code	270692213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$5,110.00
Rate for Payer: Aetna Commercial	$3,066.00
Rate for Payer: Aetna Medicare Advantage	$3,066.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,606.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,606.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,606.10
Rate for Payer: Cigna Commercial	$5,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.00

HEAD FEMORAL CERAM BIOLOX 36MM

Facility

$10,220.00

Service Code	HCPCS C1776
Hospital Charge Code	270692213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,473.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.00

HEAD FEMORAL COCR 32MM +0 12/1

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679647
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

HEAD FEMORAL COCR 32MM +0 12/1

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679647
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

HEAD FEMORAL COCR 36MM +0

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270670573
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 COCR 36MM +0

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270670573
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 LFIT 22.2MM +0MM

Facility

$1,948.70

Service Code	HCPCS C1776
Hospital Charge Code	270681296
Hospital Revenue Code	278
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$471.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.59
Rate for Payer: Qualcare PPO/HMO/WC	$292.31

HEAD FEMORAL LFIT 22.2MM +0MM

Facility

$1,948.70

Service Code	HCPCS C1776
Hospital Charge Code	270681296
Hospital Revenue Code	278
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$974.35
Rate for Payer: Aetna Commercial	$584.61
Rate for Payer: Aetna Medicare Advantage	$584.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$496.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$496.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$496.92
Rate for Payer: Cigna Commercial	$974.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.59
Rate for Payer: Qualcare PPO/HMO/WC	$292.31

HEAD FEMORAL LFIT 26MM -3MM

Facility

$2,030.70

Service Code	HCPCS C1776
Hospital Charge Code	270671303
Hospital Revenue Code	278
Min. Negotiated Rate	$304.61
Max. Negotiated Rate	$491.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.43
Rate for Payer: Qualcare PPO/HMO/WC	$304.61

Know your out-of-pocket cost for care.

All Charges