Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSERT POLYETHYLENE 10 DEGR 36

Facility

$4,836.25

Service Code	HCPCS C1776
Hospital Charge Code	270676582
Hospital Revenue Code	278
Min. Negotiated Rate	$725.44
Max. Negotiated Rate	$1,170.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.37
Rate for Payer: Qualcare PPO/HMO/WC	$725.44

INSERT POLYETHYLENE 28MM SZ C

Facility

$5,694.75

Hospital Charge Code	270676687
Hospital Revenue Code	278
Min. Negotiated Rate	$854.21
Max. Negotiated Rate	$1,378.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,138.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.13
Rate for Payer: Qualcare PPO/HMO/WC	$854.21

INSERT POLYETHYLENE 28MM SZ C

Facility

$5,694.75

Hospital Charge Code	270676687
Hospital Revenue Code	278
Min. Negotiated Rate	$854.21
Max. Negotiated Rate	$2,847.38
Rate for Payer: Aetna Commercial	$1,708.42
Rate for Payer: Aetna Medicare Advantage	$1,708.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,138.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.16
Rate for Payer: Cigna Commercial	$2,847.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.13
Rate for Payer: Qualcare PPO/HMO/WC	$854.21

INSERT POLYETHYLENE 32MM D

Facility

$8,225.75

Service Code	HCPCS C1776
Hospital Charge Code	270680444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.86
Max. Negotiated Rate	$1,990.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.86

INSERT POLYETHYLENE 32MM D

Facility

$8,225.75

Service Code	HCPCS C1776
Hospital Charge Code	270680444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.86
Max. Negotiated Rate	$4,112.88
Rate for Payer: Aetna Commercial	$2,467.72
Rate for Payer: Aetna Medicare Advantage	$2,467.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.57
Rate for Payer: Cigna Commercial	$4,112.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.86

INSERT POLYETHYLENE 36MM E

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$2,239.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT POLYETHYLENE 36MM E

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$4,628.00
Rate for Payer: Aetna Commercial	$2,776.80
Rate for Payer: Aetna Medicare Advantage	$2,776.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.28
Rate for Payer: Cigna Commercial	$4,628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT POLYETHYLENE 36MM F

Facility

$4,279.80

Service Code	HCPCS C1776
Hospital Charge Code	270677485
Hospital Revenue Code	278
Min. Negotiated Rate	$641.97
Max. Negotiated Rate	$1,035.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.71
Rate for Payer: Qualcare PPO/HMO/WC	$641.97

INSERT POLYETHYLENE 36MM F

Facility

$4,279.80

Service Code	HCPCS C1776
Hospital Charge Code	270677485
Hospital Revenue Code	278
Min. Negotiated Rate	$641.97
Max. Negotiated Rate	$2,139.90
Rate for Payer: Aetna Commercial	$1,283.94
Rate for Payer: Aetna Medicare Advantage	$1,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,091.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,091.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,091.35
Rate for Payer: Cigna Commercial	$2,139.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.71
Rate for Payer: Qualcare PPO/HMO/WC	$641.97

INSERT POLYETHYLENE 36MM G

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$4,628.00
Rate for Payer: Aetna Commercial	$2,776.80
Rate for Payer: Aetna Medicare Advantage	$2,776.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.28
Rate for Payer: Cigna Commercial	$4,628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT POLYETHYLENE 36MM G

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$2,239.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT PROLONG TIBIAL SZ2 +0

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

INSERT PROLONG TIBIAL SZ2 +0

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

INSERT P.S 17MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681470
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 P.S 17MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681470
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 P.S. 20MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679716
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 P.S. 20MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679716
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 PSN RVCK ART SUR VE18MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700044
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.75
Max. Negotiated Rate	$6,452.50
Rate for Payer: Aetna Commercial	$3,871.50
Rate for Payer: Aetna Medicare Advantage	$3,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,290.78
Rate for Payer: Cigna Commercial	$6,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75

INSERT PSN RVCK ART SUR VE18MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700044
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.75
Max. Negotiated Rate	$3,123.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75

INSERT PST POLY 20mm 183770

Facility

$5,875.00

Hospital Charge Code	270639357
Hospital Revenue Code	272
Min. Negotiated Rate	$763.75
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$763.75
Rate for Payer: Oxford Commercial	$2,937.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Commercial	$2,937.50

INSERT PST POLY 20mm 183770

Facility

$5,875.00

Hospital Charge Code	270639357
Hospital Revenue Code	272
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$881.25
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

INSERT/REPLACE PG DU

Facility

$31,274.00

Service Code	HCPCS 33228
Hospital Charge Code	7411019
Hospital Revenue Code	480
Min. Negotiated Rate	$223.43
Max. Negotiated Rate	$24,890.32
Rate for Payer: Aetna Better Health Medicaid	$16,790.24
Rate for Payer: Aetna Commercial	$9,382.20
Rate for Payer: Aetna Medicare Advantage	$9,382.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,974.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,974.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$223.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,974.87
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,065.62
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,691.10
Rate for Payer: UnitedHealthcare Commercial	$1,793.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04

INSERT/REPLACE PG DU

Facility

$31,274.00

Service Code	HCPCS 33228
Hospital Charge Code	366833228
Hospital Revenue Code	480
Min. Negotiated Rate	$223.43
Max. Negotiated Rate	$24,890.32
Rate for Payer: Aetna Better Health Medicaid	$16,790.24
Rate for Payer: Aetna Commercial	$9,382.20
Rate for Payer: Aetna Medicare Advantage	$9,382.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,974.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,974.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$223.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,974.87
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,065.62
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,691.10
Rate for Payer: UnitedHealthcare Commercial	$1,793.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04

INSERT/REPLACE PG DU

Facility

$31,274.00

Service Code	HCPCS 33228
Hospital Charge Code	366833228
Hospital Revenue Code	480
Min. Negotiated Rate	$4,691.10
Max. Negotiated Rate	$4,691.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,691.10

INSERT/REPLACE PG DU

Facility

$31,274.00

Service Code	HCPCS 33228
Hospital Charge Code	7411019
Hospital Revenue Code	480
Min. Negotiated Rate	$4,691.10
Max. Negotiated Rate	$4,691.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,691.10

Know your out-of-pocket cost for care.

All Charges