Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEM EXTEN. FEM AND TIB 14X80m

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270682016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTENSION 13 X 155

Facility

$5,245.85

Hospital Charge Code	270657121
Hospital Revenue Code	278
Min. Negotiated Rate	$786.88
Max. Negotiated Rate	$2,622.93
Rate for Payer: Aetna Commercial	$1,573.76
Rate for Payer: Aetna Medicare Advantage	$1,573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.69
Rate for Payer: Cigna Commercial	$2,622.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.50
Rate for Payer: Qualcare PPO/HMO/WC	$786.88

STEM EXTENSION 13 X 155

Facility

$5,245.85

Hospital Charge Code	270657121
Hospital Revenue Code	278
Min. Negotiated Rate	$786.88
Max. Negotiated Rate	$1,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.50
Rate for Payer: Qualcare PPO/HMO/WC	$786.88

STEM EXTENSION 15MM X 30MM

Facility

$5,245.00

Hospital Charge Code	270667171
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

STEM EXTENSION 15MM X 30MM

Facility

$5,245.00

Hospital Charge Code	270667171
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,573.50
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

STEM EXTENSION FEM TIB 12x80MM

Facility

$4,164.75

Hospital Charge Code	270675508
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,249.42
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM EXTENSION FEM TIB 12x80MM

Facility

$4,164.75

Hospital Charge Code	270675508
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM EXTENSION FEM TIB 18X80MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270670651
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,249.42
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM EXTENSION FEM TIB 18X80MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270670651
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM EXTENSION SCREW REPLAC

Facility

$823.33

Hospital Charge Code	270657078
Hospital Revenue Code	278
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$411.67
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$247.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.95
Rate for Payer: Cigna Commercial	$411.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.25
Rate for Payer: Qualcare PPO/HMO/WC	$123.50

STEM EXTENSION SCREW REPLAC

Facility

$823.33

Hospital Charge Code	270657078
Hospital Revenue Code	278
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$199.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.25
Rate for Payer: Qualcare PPO/HMO/WC	$123.50

STEM EXT FEMORAL TIB 14X80MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668747
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

STEM EXT FEMORAL TIB 14X80MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668747
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

STEM EXT FEM &TIB CEM 10x80MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270680667
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$3,303.00
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXT FEM &TIB CEM 10x80MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270680667
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXT FEM &TIB CEM 12x80MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270680666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXT FEM &TIB CEM 12x80MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270680666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$3,303.00
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXT TAPERED SMTH PSN 14X7

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270690151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$4,386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

STEM EXT TAPERED SMTH PSN 14X7

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270690151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$5,437.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

STEM FEM 12/14 TAPER SZ6 127MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699296
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

STEM FEM 12/14 TAPER SZ6 127MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699296
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

STEM FEM 12/14 TAP SZ 5 120MM

Facility

$9,710.00

Service Code	HCPCS C1776
Hospital Charge Code	270697315
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$4,855.00
Rate for Payer: Aetna Commercial	$2,913.00
Rate for Payer: Aetna Medicare Advantage	$2,913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,476.05
Rate for Payer: Cigna Commercial	$4,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,349.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.50

STEM FEM 12/14 TAP SZ 5 120MM

Facility

$9,710.00

Service Code	HCPCS C1776
Hospital Charge Code	270697315
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,349.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,349.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.50

STEM FEM 13X14 STDBODY 784113

Facility

$19,519.40

Hospital Charge Code	270629822
Hospital Revenue Code	278
Min. Negotiated Rate	$2,927.91
Max. Negotiated Rate	$9,759.70
Rate for Payer: Aetna Commercial	$5,855.82
Rate for Payer: Aetna Medicare Advantage	$5,855.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,977.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,977.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,903.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,977.45
Rate for Payer: Cigna Commercial	$9,759.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,723.69
Rate for Payer: Qualcare PPO/HMO/WC	$2,927.91

STEM FEM 13X14 STDBODY 784113

Facility

$19,519.40

Hospital Charge Code	270629822
Hospital Revenue Code	278
Min. Negotiated Rate	$2,927.91
Max. Negotiated Rate	$4,723.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,903.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,723.69
Rate for Payer: Qualcare PPO/HMO/WC	$2,927.91

Know your out-of-pocket cost for care.

All Charges