Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT EXT HIGH PROFILE 600cc

Facility

$3,750.00

Hospital Charge Code	270673557
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT FIBULOCK SYST

Facility

$3,500.00

Hospital Charge Code	270690433
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$1,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$1,750.00

IMPLANT FIBULOCK SYST

Facility

$3,500.00

Hospital Charge Code	270690433
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

IMPLANT HEMI PHALANG CANN #1

Facility

$3,687.50

Service Code	HCPCS C1776
Hospital Charge Code	270676441
Hospital Revenue Code	278
Min. Negotiated Rate	$553.12
Max. Negotiated Rate	$1,843.75
Rate for Payer: Aetna Commercial	$1,106.25
Rate for Payer: Aetna Medicare Advantage	$1,106.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$940.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$940.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$940.31
Rate for Payer: Cigna Commercial	$1,843.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.38
Rate for Payer: Qualcare PPO/HMO/WC	$553.12

IMPLANT HEMI PHALANG CANN #1

Facility

$3,687.50

Service Code	HCPCS C1776
Hospital Charge Code	270676441
Hospital Revenue Code	278
Min. Negotiated Rate	$553.12
Max. Negotiated Rate	$892.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.38
Rate for Payer: Qualcare PPO/HMO/WC	$553.12

IMPLANT HEMI PHALANG CANN #2

Facility

$7,375.00

Hospital Charge Code	270676442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,212.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #2

Facility

$7,375.00

Hospital Charge Code	270676442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #3

Facility

$7,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270670543
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #3

Facility

$7,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270670543
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,212.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #4

Facility

$7,375.00

Hospital Charge Code	270676443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,212.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #4

Facility

$7,375.00

Hospital Charge Code	270676443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #5

Facility

$7,375.00

Hospital Charge Code	270676444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HEMI PHALANG CANN #5

Facility

$7,375.00

Hospital Charge Code	270676444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,212.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

IMPLANT HIGH PROFILE 400cc

Facility

$3,750.00

Hospital Charge Code	270673553
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 400cc

Facility

$3,750.00

Hospital Charge Code	270673553
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 450cc

Facility

$3,750.00

Hospital Charge Code	270673554
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 450cc

Facility

$3,750.00

Hospital Charge Code	270673554
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 500CC

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270669961
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 500CC

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270669961
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 550CC

Facility

$4,635.00

Hospital Charge Code	669962
Hospital Revenue Code	278
Min. Negotiated Rate	$695.25
Max. Negotiated Rate	$1,121.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,121.67
Rate for Payer: Qualcare PPO/HMO/WC	$695.25

IMPLANT HIGH PROFILE 550CC

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270669962
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 550CC

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270669962
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 550CC

Facility

$4,635.00

Hospital Charge Code	669962
Hospital Revenue Code	278
Min. Negotiated Rate	$695.25
Max. Negotiated Rate	$2,317.50
Rate for Payer: Aetna Commercial	$1,390.50
Rate for Payer: Aetna Medicare Advantage	$1,390.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,181.92
Rate for Payer: Cigna Commercial	$2,317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,121.67
Rate for Payer: Qualcare PPO/HMO/WC	$695.25

IMPLANT HIGH PROFILE 600CC

Facility

$3,750.00

Hospital Charge Code	270669963
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 600CC

Facility

$3,750.00

Hospital Charge Code	270669963
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Know your out-of-pocket cost for care.

All Charges