Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEM CEMENTED IM 11 X 225 MM

Facility

$15,252.00

Service Code	HCPCS C1776
Hospital Charge Code	270690276
Hospital Revenue Code	278
Min. Negotiated Rate	$2,287.80
Max. Negotiated Rate	$3,690.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,050.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,690.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,287.80

STEM CEMENTED IM 11 X 225 MM

Facility

$15,252.00

Service Code	HCPCS C1776
Hospital Charge Code	270690276
Hospital Revenue Code	278
Min. Negotiated Rate	$2,287.80
Max. Negotiated Rate	$7,626.00
Rate for Payer: Aetna Commercial	$4,575.60
Rate for Payer: Aetna Medicare Advantage	$4,575.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.26
Rate for Payer: Cigna Commercial	$7,626.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,690.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,287.80

STEM CEMENTLESS FINNED 15MM

Facility

$4,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270669578
Hospital Revenue Code	278
Min. Negotiated Rate	$686.25
Max. Negotiated Rate	$1,107.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,107.15
Rate for Payer: Qualcare PPO/HMO/WC	$686.25

STEM CEMENTLESS FINNED 15MM

Facility

$4,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270669578
Hospital Revenue Code	278
Min. Negotiated Rate	$686.25
Max. Negotiated Rate	$2,287.50
Rate for Payer: Aetna Commercial	$1,372.50
Rate for Payer: Aetna Medicare Advantage	$1,372.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,166.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,166.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,166.62
Rate for Payer: Cigna Commercial	$2,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,107.15
Rate for Payer: Qualcare PPO/HMO/WC	$686.25

STEM CEMENTLESS FINNED 19MM

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270675413
Hospital Revenue Code	278
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$1,306.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,306.80
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

STEM CEMENTLESS FINNED 19MM

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270675413
Hospital Revenue Code	278
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$2,700.00
Rate for Payer: Aetna Commercial	$1,620.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,306.80
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

STEM CEMENTRALIZER 10.0MM

Facility

$375.00

Service Code	HCPCS C1776
Hospital Charge Code	270691696
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

STEM CEMENTRALIZER 10.0MM

Facility

$375.00

Service Code	HCPCS C1776
Hospital Charge Code	270691696
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

STEM CEMENTRALIZER 8.5MM

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698952
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

STEM CEMENTRALIZER 8.5MM

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698952
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$787.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

STEM CEMENTRAZLER 9.25MM

Facility

$375.00

Service Code	HCPCS C1776
Hospital Charge Code	270696313
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

STEM CEMENTRAZLER 9.25MM

Facility

$375.00

Service Code	HCPCS C1776
Hospital Charge Code	270696313
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

STEM CEM IM OSS 13X150

Facility

$14,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270691646
Hospital Revenue Code	278
Min. Negotiated Rate	$2,146.50
Max. Negotiated Rate	$3,463.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,862.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,463.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,146.50

STEM CEM IM OSS 13X150

Facility

$14,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270691646
Hospital Revenue Code	278
Min. Negotiated Rate	$2,146.50
Max. Negotiated Rate	$7,155.00
Rate for Payer: Aetna Commercial	$4,293.00
Rate for Payer: Aetna Medicare Advantage	$4,293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,649.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,649.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,649.05
Rate for Payer: Cigna Commercial	$7,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,463.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,146.50

STEM CENTRALIZER 10.5 CEMENTED

Facility

$393.75

Service Code	HCPCS C1776
Hospital Charge Code	270700571
Hospital Revenue Code	278
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$95.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.29
Rate for Payer: Qualcare PPO/HMO/WC	$59.06

STEM CENTRALIZER 10.5 CEMENTED

Facility

$393.75

Service Code	HCPCS C1776
Hospital Charge Code	270700571
Hospital Revenue Code	278
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$196.88
Rate for Payer: Aetna Commercial	$118.12
Rate for Payer: Aetna Medicare Advantage	$118.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.41
Rate for Payer: Cigna Commercial	$196.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.29
Rate for Payer: Qualcare PPO/HMO/WC	$59.06

STEM COLLARED 11MMX135MM

Facility

$19,180.00

Hospital Charge Code	270662231
Hospital Revenue Code	278
Min. Negotiated Rate	$2,877.00
Max. Negotiated Rate	$4,641.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,641.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,877.00

STEM COLLARED 11MMX135MM

Facility

$19,180.00

Hospital Charge Code	270662231
Hospital Revenue Code	278
Min. Negotiated Rate	$2,877.00
Max. Negotiated Rate	$9,590.00
Rate for Payer: Aetna Commercial	$5,754.00
Rate for Payer: Aetna Medicare Advantage	$5,754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,890.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,890.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,890.90
Rate for Payer: Cigna Commercial	$9,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,641.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,877.00

STEM COLLARED STD 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687120
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687120
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687121
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687121
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688585
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688585
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COMPLETE XR 123 DEG SZ 8

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694946
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

Know your out-of-pocket cost for care.

All Charges