Heights University Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL STEM #113637

Facility

$23,000.00

Hospital Charge Code	270702536
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$6,900.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

HUMERAL STEM LF 12.5MM

Facility

$9,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270684768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

HUMERAL STEM LF 12.5MM

Facility

$9,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270684768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$2,751.00
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

HUMERAL STEM LF 6.5MM

Facility

$20,025.00

Hospital Charge Code	270668549
Hospital Revenue Code	278
Min. Negotiated Rate	$3,003.75
Max. Negotiated Rate	$4,846.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75

HUMERAL STEM LF 6.5MM

Facility

$20,025.00

Hospital Charge Code	270668549
Hospital Revenue Code	278
Min. Negotiated Rate	$3,003.75
Max. Negotiated Rate	$10,012.50
Rate for Payer: Aetna Commercial	$6,007.50
Rate for Payer: Aetna Medicare Advantage	$6,007.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,106.38
Rate for Payer: Cigna Commercial	$10,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75

HUMERAL STEM PRIMARY 11MM

Facility

$9,998.75

Service Code	HCPCS C1776
Hospital Charge Code	270669342
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.81
Max. Negotiated Rate	$4,999.38
Rate for Payer: Aetna Commercial	$2,999.62
Rate for Payer: Aetna Medicare Advantage	$2,999.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,549.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,549.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,999.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,549.68
Rate for Payer: Cigna Commercial	$4,999.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,419.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,499.81

HUMERAL STEM PRIMARY 11MM

Facility

$9,998.75

Service Code	HCPCS C1776
Hospital Charge Code	270669342
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.81
Max. Negotiated Rate	$2,419.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,999.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,419.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,499.81

HUMERAL STEM PRIMARY 13MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270669658
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$4,584.93
Rate for Payer: Aetna Commercial	$2,750.95
Rate for Payer: Aetna Medicare Advantage	$2,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.31
Rate for Payer: Cigna Commercial	$4,584.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRIMARY 13MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270669658
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$2,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRIMARY 17MM

Facility

$9,169.85

Hospital Charge Code	270675722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$4,584.93
Rate for Payer: Aetna Commercial	$2,750.95
Rate for Payer: Aetna Medicare Advantage	$2,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.31
Rate for Payer: Cigna Commercial	$4,584.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRIMARY 17MM

Facility

$9,169.85

Hospital Charge Code	270675722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$2,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRM PRESS FIT 9MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270673290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$2,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRM PRESS FIT 9MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270673290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$4,584.93
Rate for Payer: Aetna Commercial	$2,750.95
Rate for Payer: Aetna Medicare Advantage	$2,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.31
Rate for Payer: Cigna Commercial	$4,584.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM RIGHT 10.5MM

Facility

$20,025.00

Hospital Charge Code	270668560
Hospital Revenue Code	278
Min. Negotiated Rate	$3,003.75
Max. Negotiated Rate	$4,846.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75

HUMERAL STEM RIGHT 10.5MM

Facility

$20,025.00

Hospital Charge Code	270668560
Hospital Revenue Code	278
Min. Negotiated Rate	$3,003.75
Max. Negotiated Rate	$10,012.50
Rate for Payer: Aetna Commercial	$6,007.50
Rate for Payer: Aetna Medicare Advantage	$6,007.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,106.38
Rate for Payer: Cigna Commercial	$10,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75

HUMERAL STEM STANDARD SZ 11

Facility

$23,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700221
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$5,566.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

HUMERAL STEM STANDARD SZ 11

Facility

$23,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700221
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$6,900.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

HUMERAL STEM STD SHORTSZ3

Facility

$47,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270700532
Hospital Revenue Code	278
Min. Negotiated Rate	$7,180.50
Max. Negotiated Rate	$23,935.00
Rate for Payer: Aetna Commercial	$14,361.00
Rate for Payer: Aetna Medicare Advantage	$14,361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,206.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,206.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,206.85
Rate for Payer: Cigna Commercial	$23,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,584.54
Rate for Payer: Qualcare PPO/HMO/WC	$7,180.50

HUMERAL STEM STD SHORTSZ3

Facility

$47,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270700532
Hospital Revenue Code	278
Min. Negotiated Rate	$7,180.50
Max. Negotiated Rate	$11,584.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,584.54
Rate for Payer: Qualcare PPO/HMO/WC	$7,180.50

HUMERAL TRAY #110031406

Facility

$10,500.00

Hospital Charge Code	270702533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

HUMERAL TRAY #110031406

Facility

$10,500.00

Hospital Charge Code	270702533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

HUMERAL TRAY +5 44MM

Facility

$7,500.00

Hospital Charge Code	270671258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HUMERAL TRAY +5 44MM

Facility

$7,500.00

Hospital Charge Code	270671258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HUMERAL X3 INSERT 36x2MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671583
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$1,950.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

HUMERAL X3 INSERT 36x2MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671583
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

Know your out-of-pocket cost for care.

All Charges