Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMOR BIOLOX OPTION 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698184
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 FEMOR BIOLOX OPTION 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698184
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 FEM UHR BIPOLAR 28X44MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697699
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$2,916.65
Rate for Payer: Aetna Commercial	$1,749.99
Rate for Payer: Aetna Medicare Advantage	$1,749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,487.49
Rate for Payer: Cigna Commercial	$2,916.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

HEAD FEM UHR BIPOLAR 28X44MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697699
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$1,411.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

HEAD FEMUR COCR HD 28X3.5

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700084
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

HEAD FEMUR COCR HD 28X3.5

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700084
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$1,543.75
Rate for Payer: Aetna Commercial	$926.25
Rate for Payer: Aetna Medicare Advantage	$926.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.31
Rate for Payer: Cigna Commercial	$1,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

HEAD FEMUR COMP CMPL SZ 4

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694675
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$4,436.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

HEAD FEMUR COMP CMPL SZ 4

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694675
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

HEAD FERMORAL COCR 36mm -6mm

Facility

$3,005.00

Hospital Charge Code	270640066
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$901.50
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD FERMORAL COCR 36mm -6mm

Facility

$3,005.00

Hospital Charge Code	270640066
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD FOR FEMORAL HEAD IMPACTOR

Facility

$350.00

Hospital Charge Code	270673263
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

HEAD FOR FEMORAL HEAD IMPACTOR

Facility

$350.00

Hospital Charge Code	270673263
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

HEADGEAR PERFRMAX ADLT 1045314

Facility

$803.45

Hospital Charge Code	270645033
Hospital Revenue Code	272
Min. Negotiated Rate	$104.45
Max. Negotiated Rate	$401.73
Rate for Payer: Aetna Commercial	$241.03
Rate for Payer: Aetna Medicare Advantage	$241.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.88
Rate for Payer: Cigna Commercial	$401.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.45
Rate for Payer: Oxford Commercial	$401.73
Rate for Payer: Qualcare PPO/HMO/WC	$120.52
Rate for Payer: UnitedHealthcare Commercial	$401.73

HEADGEAR PERFRMAX ADLT 1045314

Facility

$803.45

Hospital Charge Code	270645033
Hospital Revenue Code	272
Min. Negotiated Rate	$120.52
Max. Negotiated Rate	$120.52
Rate for Payer: Qualcare PPO/HMO/WC	$120.52

HEAD GLENO TM REVERSE 36MM 0D

Facility

$6,847.50

Service Code	HCPCS C1776
Hospital Charge Code	270696093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.12
Max. Negotiated Rate	$3,423.75
Rate for Payer: Aetna Commercial	$2,054.25
Rate for Payer: Aetna Medicare Advantage	$2,054.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.11
Rate for Payer: Cigna Commercial	$3,423.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.12

HEAD GLENO TM REVERSE 36MM 0D

Facility

$6,847.50

Service Code	HCPCS C1776
Hospital Charge Code	270696093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.12
Max. Negotiated Rate	$1,657.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.12

HEAD HEMI METASARSAL CANN 14mm

Facility

$12,250.00

Hospital Charge Code	270676436
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 14mm

Facility

$12,250.00

Hospital Charge Code	270676436
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 16mm

Facility

$12,250.00

Hospital Charge Code	270676437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 16mm

Facility

$12,250.00

Hospital Charge Code	270676437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 18mm

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270676438
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$1,482.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

HEAD HEMI METASARSAL CANN 18mm

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270676438
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$3,062.50
Rate for Payer: Aetna Commercial	$1,837.50
Rate for Payer: Aetna Medicare Advantage	$1,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.88
Rate for Payer: Cigna Commercial	$3,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

HEAD HEMI METASARSAL CANN 20mm

Facility

$12,250.00

Hospital Charge Code	270676439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 20mm

Facility

$12,250.00

Hospital Charge Code	270676439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 22mm

Facility

$12,250.00

Hospital Charge Code	270676440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

Know your out-of-pocket cost for care.

All Charges