Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD PROLINE IMPLANT 20MM

Facility

$9,860.00

Service Code	HCPCS C1776
Hospital Charge Code	270679303
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$4,930.00
Rate for Payer: Aetna Commercial	$2,958.00
Rate for Payer: Aetna Medicare Advantage	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.30
Rate for Payer: Cigna Commercial	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00

HEAD PROLINE IMPLANT 20MM

Facility

$9,860.00

Service Code	HCPCS C1776
Hospital Charge Code	270679303
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$2,386.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00

HEAD PROLINE IMPLANT 24MM

Facility

$9,860.00

Hospital Charge Code	270628374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$4,930.00
Rate for Payer: Aetna Commercial	$2,958.00
Rate for Payer: Aetna Medicare Advantage	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.30
Rate for Payer: Cigna Commercial	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00

HEAD PROLINE IMPLANT 24MM

Facility

$9,860.00

Hospital Charge Code	270628374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$2,386.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00

HEAD PROLINE SZ+2 OD 20MM

Facility

$8,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270686805
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$2,692.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

HEAD PROLINE SZ+2 OD 20MM

Facility

$8,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270686805
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

HEAD RADIAL 19X5.5MM STM 9MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270696685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.47
Max. Negotiated Rate	$4,284.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.47

HEAD RADIAL 19X5.5MM STM 9MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270696685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.47
Max. Negotiated Rate	$8,851.58
Rate for Payer: Aetna Commercial	$5,310.94
Rate for Payer: Aetna Medicare Advantage	$5,310.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,514.30
Rate for Payer: Cigna Commercial	$8,851.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.47

HEAD RADIAL 22MM RIGT

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270687185
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

HEAD RADIAL 22MM RIGT

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270687185
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$5,598.00
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

HEAD RADIAL 22MMX6.5MMX6MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270695502
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.47
Max. Negotiated Rate	$8,851.58
Rate for Payer: Aetna Commercial	$5,310.94
Rate for Payer: Aetna Medicare Advantage	$5,310.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,514.30
Rate for Payer: Cigna Commercial	$8,851.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.47

HEAD RADIAL 22MMX6.5MMX6MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270695502
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.47
Max. Negotiated Rate	$4,284.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.47

HEAD RADIAL 22X5.5X3MM

Facility

$17,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270697683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.00
Max. Negotiated Rate	$8,850.00
Rate for Payer: Aetna Commercial	$5,310.00
Rate for Payer: Aetna Medicare Advantage	$5,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,513.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,513.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,513.50
Rate for Payer: Cigna Commercial	$8,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,283.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.00

HEAD RADIAL 22X5.5X3MM

Facility

$17,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270697683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.00
Max. Negotiated Rate	$4,283.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,283.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.00

HEAD RADIAl 9.0 X 2.0MM

Facility

$11,585.00

Service Code	HCPCS C1776
Hospital Charge Code	270687186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.75
Max. Negotiated Rate	$5,792.50
Rate for Payer: Aetna Commercial	$3,475.50
Rate for Payer: Aetna Medicare Advantage	$3,475.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,954.18
Rate for Payer: Cigna Commercial	$5,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75

HEAD RADIAl 9.0 X 2.0MM

Facility

$11,585.00

Service Code	HCPCS C1776
Hospital Charge Code	270687186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.75
Max. Negotiated Rate	$2,803.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75

HEAD RADIAL ALIGN 22MM

Facility

$11,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$3,525.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

HEAD RADIAL ALIGN 22MM

Facility

$11,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

HEAD RADIAL ELBOW 16x22MM

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

HEAD RADIAL ELBOW 16x22MM

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

HEAD RADIAL LT SYSTEM 20MM

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693319
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 RADIAL LT SYSTEM 20MM

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693319
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

HEADREST 7 PILLOW GENTLE 1937

Facility

$35.10

Hospital Charge Code	270631284
Hospital Revenue Code	270
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Oxford Commercial	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.26
Rate for Payer: UnitedHealthcare Commercial	$17.55

HEADREST 7 PILLOW GENTLE 1937

Facility

$35.10

Hospital Charge Code	270631284
Hospital Revenue Code	270
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$5.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.26

HEAD RIGHT 22MM TR ANGLED

Facility

$16,125.00

Hospital Charge Code	270666835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

Know your out-of-pocket cost for care.

All Charges