Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD UNIV BIPOLAR 46X26MM

Facility

$2,745.55

Service Code	HCPCS C1776
Hospital Charge Code	270700360
Hospital Revenue Code	278
Min. Negotiated Rate	$411.83
Max. Negotiated Rate	$1,372.78
Rate for Payer: Aetna Commercial	$823.66
Rate for Payer: Aetna Medicare Advantage	$823.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$700.12
Rate for Payer: Cigna Commercial	$1,372.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.42
Rate for Payer: Qualcare PPO/HMO/WC	$411.83

HEAD UNIV BIPOLAR 46X26MM

Facility

$2,745.55

Service Code	HCPCS C1776
Hospital Charge Code	270700360
Hospital Revenue Code	278
Min. Negotiated Rate	$411.83
Max. Negotiated Rate	$664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.42
Rate for Payer: Qualcare PPO/HMO/WC	$411.83

HEAD UNIVERSAL

Facility

$8,380.00

Service Code	HCPCS C1776
Hospital Charge Code	270660307
Hospital Revenue Code	278
Min. Negotiated Rate	$1,257.00
Max. Negotiated Rate	$4,190.00
Rate for Payer: Aetna Commercial	$2,514.00
Rate for Payer: Aetna Medicare Advantage	$2,514.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,136.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,136.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,136.90
Rate for Payer: Cigna Commercial	$4,190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,257.00

HEAD UNIVERSAL

Facility

$8,380.00

Service Code	HCPCS C1776
Hospital Charge Code	270660307
Hospital Revenue Code	278
Min. Negotiated Rate	$1,257.00
Max. Negotiated Rate	$2,027.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,676.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,257.00

HEAD UNIVERSAL 47x28MM

Facility

$2,933.00

Service Code	HCPCS C1776
Hospital Charge Code	270676940
Hospital Revenue Code	278
Min. Negotiated Rate	$439.95
Max. Negotiated Rate	$1,466.50
Rate for Payer: Aetna Commercial	$879.90
Rate for Payer: Aetna Medicare Advantage	$879.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$747.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$747.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$747.91
Rate for Payer: Cigna Commercial	$1,466.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$709.79
Rate for Payer: Qualcare PPO/HMO/WC	$439.95

HEAD UNIVERSAL 47x28MM

Facility

$2,933.00

Service Code	HCPCS C1776
Hospital Charge Code	270676940
Hospital Revenue Code	278
Min. Negotiated Rate	$439.95
Max. Negotiated Rate	$709.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$709.79
Rate for Payer: Qualcare PPO/HMO/WC	$439.95

HEAD UNIVERSAL 49 x 26MM

Facility

$3,763.65

Service Code	HCPCS C1776
Hospital Charge Code	270681701
Hospital Revenue Code	278
Min. Negotiated Rate	$564.55
Max. Negotiated Rate	$1,881.83
Rate for Payer: Aetna Commercial	$1,129.10
Rate for Payer: Aetna Medicare Advantage	$1,129.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$959.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$959.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$752.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$959.73
Rate for Payer: Cigna Commercial	$1,881.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.80
Rate for Payer: Qualcare PPO/HMO/WC	$564.55

HEAD UNIVERSAL 49 x 26MM

Facility

$3,763.65

Service Code	HCPCS C1776
Hospital Charge Code	270681701
Hospital Revenue Code	278
Min. Negotiated Rate	$564.55
Max. Negotiated Rate	$910.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$752.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.80
Rate for Payer: Qualcare PPO/HMO/WC	$564.55

HEAD UNIVERSAL 50x28MM

Facility

$3,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270676560
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

HEAD UNIVERSAL 50x28MM

Facility

$3,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270676560
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,131.00
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

HEAD UNIVERSAL 54x26MM

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270680587
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

HEAD UNIVERSAL 54x26MM

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270680587
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$1,682.85
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

HEAD UNIVERSAL BIPOL 43X26MM

Facility

$7,675.00

Service Code	HCPCS C1776
Hospital Charge Code	270694418
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$1,857.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

HEAD UNIVERSAL BIPOL 43X26MM

Facility

$7,675.00

Service Code	HCPCS C1776
Hospital Charge Code	270694418
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$3,837.50
Rate for Payer: Aetna Commercial	$2,302.50
Rate for Payer: Aetna Medicare Advantage	$2,302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.12
Rate for Payer: Cigna Commercial	$3,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

HEAD UNIVERSAL BIPOLAR 42x26MM

Facility

$2,743.60

Service Code	HCPCS C1776
Hospital Charge Code	270673426
Hospital Revenue Code	278
Min. Negotiated Rate	$411.54
Max. Negotiated Rate	$1,371.80
Rate for Payer: Aetna Commercial	$823.08
Rate for Payer: Aetna Medicare Advantage	$823.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.62
Rate for Payer: Cigna Commercial	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: Qualcare PPO/HMO/WC	$411.54

HEAD UNIVERSAL BIPOLAR 42x26MM

Facility

$2,743.60

Service Code	HCPCS C1776
Hospital Charge Code	270673426
Hospital Revenue Code	278
Min. Negotiated Rate	$411.54
Max. Negotiated Rate	$663.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: Qualcare PPO/HMO/WC	$411.54

HEAD VERSA 46MMX21MMX50MM HUM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687428
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

HEAD VERSA 46MMX21MMX50MM HUM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687428
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

HEAD W/CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70460
Hospital Charge Code	2200012
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HEAD W/CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70460
Hospital Charge Code	2200012
Hospital Revenue Code	351
Min. Negotiated Rate	$262.90
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

HEAD W/O CONTR

Facility

$9,500.00

Service Code	HCPCS 70450
Hospital Charge Code	2200020
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HEAD W/O CONTR

Facility

$9,500.00

Service Code	HCPCS 70450
Hospital Charge Code	2200020
Hospital Revenue Code	351
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

HEAD W/WO CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70470
Hospital Charge Code	2200038
Hospital Revenue Code	351
Min. Negotiated Rate	$321.27
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

HEAD W/WO CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70470
Hospital Charge Code	2200038
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HEAD XL DELTA BIOLOX 32MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683290
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

Know your out-of-pocket cost for care.

All Charges