Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEM IM BOWE 14x150 150368

Facility

$6,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270638567
Hospital Revenue Code	278
Min. Negotiated Rate	$972.00
Max. Negotiated Rate	$1,568.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.16
Rate for Payer: Qualcare PPO/HMO/WC	$972.00

STEM IM OSS BOWED 12.5x150mm

Facility

$10,530.00

Service Code	HCPCS C1776
Hospital Charge Code	270673538
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.50
Max. Negotiated Rate	$5,265.00
Rate for Payer: Aetna Commercial	$3,159.00
Rate for Payer: Aetna Medicare Advantage	$3,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.15
Rate for Payer: Cigna Commercial	$5,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50

STEM IM OSS BOWED 12.5x150mm

Facility

$10,530.00

Service Code	HCPCS C1776
Hospital Charge Code	270673538
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.50
Max. Negotiated Rate	$2,548.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50

STEM IM OSS STR 12.5x150mm

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270673539
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$1,249.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

STEM IM OSS STR 12.5x150mm

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270673539
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$2,582.50
Rate for Payer: Aetna Commercial	$1,549.50
Rate for Payer: Aetna Medicare Advantage	$1,549.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.08
Rate for Payer: Cigna Commercial	$2,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

STEM INTEG COL POROUS 15x155mm

Facility

$19,180.00

Hospital Charge Code	270645158
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 INTEG COL POROUS 15x155mm

Facility

$19,180.00

Hospital Charge Code	270645158
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 INTEG POROUS 16mm X170316

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270637574
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 INTEG POROUS 16mm X170316

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270637574
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 INTEGRAL 11x145MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270641366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

STEM INTEGRAL 11x145MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270641366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

STEM INTEGRAL 12x140MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270642105
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

STEM INTEGRAL 12x140MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270642105
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

STEM INTEGRAL 13MM X 145MM PC

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270637437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

STEM INTEGRAL 13MM X 145MM PC

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270637437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

STEM INTEGRAL 14mm

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270636663
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 INTEGRAL 14mm

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270636663
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 INTEGRAL 7x115 X12-171307

Facility

$19,180.00

Hospital Charge Code	270658432
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 INTEGRAL 7x115 X12-171307

Facility

$19,180.00

Hospital Charge Code	270658432
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 INTEGRAL FEM 14 X11170314

Facility

$19,915.00

Hospital Charge Code	270638622
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$9,957.50
Rate for Payer: Aetna Commercial	$5,974.50
Rate for Payer: Aetna Medicare Advantage	$5,974.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,078.32
Rate for Payer: Cigna Commercial	$9,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

STEM INTEGRAL FEM 14 X11170314

Facility

$19,915.00

Hospital Charge Code	270638622
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$4,819.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

STEM INTEGRAL POR0S 13 X170313

Facility

$19,915.00

Hospital Charge Code	270634656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$9,957.50
Rate for Payer: Aetna Commercial	$5,974.50
Rate for Payer: Aetna Medicare Advantage	$5,974.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,078.32
Rate for Payer: Cigna Commercial	$9,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

STEM INTEGRAL POR0S 13 X170313

Facility

$19,915.00

Hospital Charge Code	270634656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$4,819.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

STEM INTEGRAL POROUS 11mm

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270637208
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

STEM INTEGRAL POROUS 11mm

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270637208
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
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