Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSERT FEMUR SZ 3 RIGHT 12MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678167
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT FEMUR SZ 3 RIGHT 12MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678167
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT FLEX LEFT 14MM S3

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681758
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

INSERT FLEX LEFT 14MM S3

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681758
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

INSERT FLEX SPHERE 10MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678630
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE 10MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678630
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE 12MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681366
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE 12MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681366
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE LEFT 12MM S

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683574
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE LEFT 12MM S

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683574
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE R 17MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE R 17MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE RIGHT 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687605
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE RIGHT 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687605
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE S3 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683109
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE S3 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683109
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FOR ADM MDM 28/48MM 42E

Facility

$4,081.30

Service Code	HCPCS C1776
Hospital Charge Code	270646337
Hospital Revenue Code	278
Min. Negotiated Rate	$612.20
Max. Negotiated Rate	$987.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.67
Rate for Payer: Qualcare PPO/HMO/WC	$612.20

INSERT FOR ADM MDM 28/48MM 42E

Facility

$4,081.30

Service Code	HCPCS C1776
Hospital Charge Code	270646337
Hospital Revenue Code	278
Min. Negotiated Rate	$612.20
Max. Negotiated Rate	$2,040.65
Rate for Payer: Aetna Commercial	$1,224.39
Rate for Payer: Aetna Medicare Advantage	$1,224.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.73
Rate for Payer: Cigna Commercial	$2,040.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.67
Rate for Payer: Qualcare PPO/HMO/WC	$612.20

INSERT FOR ADM/MDM 28/52MM 48f

Facility

$8,250.00

Hospital Charge Code	270684945
Hospital Revenue Code	272
Min. Negotiated Rate	$1,072.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,072.50
Rate for Payer: Oxford Commercial	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Commercial	$4,125.00

INSERT FOR ADM/MDM 28/52MM 48f

Facility

$8,250.00

Hospital Charge Code	270684945
Hospital Revenue Code	272
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR ADM/MDM 28/54MM 48G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR ADM/MDM 28/54MM 48G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR MDM LINER 22.2MM 36

Facility

$4,465.10

Service Code	HCPCS C1776
Hospital Charge Code	270682914
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$1,080.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.55
Rate for Payer: Qualcare PPO/HMO/WC	$669.76

INSERT FOR MDM LINER 22.2MM 36

Facility

$4,465.10

Service Code	HCPCS C1776
Hospital Charge Code	270682914
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$2,232.55
Rate for Payer: Aetna Commercial	$1,339.53
Rate for Payer: Aetna Medicare Advantage	$1,339.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,138.60
Rate for Payer: Cigna Commercial	$2,232.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.55
Rate for Payer: Qualcare PPO/HMO/WC	$669.76

INSERT FOR MDM LINER 22.2MM 38

Facility

$4,055.65

Service Code	HCPCS C1776
Hospital Charge Code	270681379
Hospital Revenue Code	278
Min. Negotiated Rate	$608.35
Max. Negotiated Rate	$2,027.83
Rate for Payer: Aetna Commercial	$1,216.69
Rate for Payer: Aetna Medicare Advantage	$1,216.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,034.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,034.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$811.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,034.19
Rate for Payer: Cigna Commercial	$2,027.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.47
Rate for Payer: Qualcare PPO/HMO/WC	$608.35

Know your out-of-pocket cost for care.

All Charges