Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEM INTEGRAL POROUS 12MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270638652
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 POROUS 12MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270638652
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 POROUS 14mm

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270636875
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 POROUS 14mm

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270636875
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 POROUS 15mm

Facility

$19,755.75

Hospital Charge Code	270636168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,963.36
Max. Negotiated Rate	$4,780.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36

STEM INTEGRAL POROUS 15mm

Facility

$19,755.75

Hospital Charge Code	270636168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,963.36
Max. Negotiated Rate	$9,877.88
Rate for Payer: Aetna Commercial	$5,926.73
Rate for Payer: Aetna Medicare Advantage	$5,926.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,037.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,037.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,037.72
Rate for Payer: Cigna Commercial	$9,877.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36

STEM INTEGRAL POROUS 9mm170309

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270641192
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 POROUS 9mm170309

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270641192
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 INTEL RP 16x160 X12171316

Facility

$19,915.00

Hospital Charge Code	270642851
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 INTEL RP 16x160 X12171316

Facility

$19,915.00

Hospital Charge Code	270642851
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 INTGRAL POROUS 10 X170310

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270639542
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 INTGRAL POROUS 10 X170310

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270639542
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 INTGRL 9MMx12 X12-171309

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270658427
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 INTGRL 9MMx12 X12-171309

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270658427
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 KNEE SMOOTH BMT

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270692339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$1,844.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

STEM KNEE SMOOTH BMT

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270692339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$3,810.00
Rate for Payer: Aetna Commercial	$2,286.00
Rate for Payer: Aetna Medicare Advantage	$2,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,943.10
Rate for Payer: Cigna Commercial	$3,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

STEM KNEE SMTH W/SCREW 10x80mm

Facility

$8,075.00

Hospital Charge Code	270665689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.25
Max. Negotiated Rate	$4,037.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,059.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,059.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,059.12
Rate for Payer: Cigna Commercial	$4,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,954.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,211.25

STEM KNEE SMTH W/SCREW 10x80mm

Facility

$8,075.00

Hospital Charge Code	270665689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.25
Max. Negotiated Rate	$1,954.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,954.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,211.25

STEM KNEE SMTH W/SCREW 12x80mm

Facility

$7,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270647561
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$1,844.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

STEM KNEE SMTH W/SCREW 12x80mm

Facility

$7,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270647561
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$3,810.00
Rate for Payer: Aetna Commercial	$2,286.00
Rate for Payer: Aetna Medicare Advantage	$2,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,943.10
Rate for Payer: Cigna Commercial	$3,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

STEM KNEE SMTH W/SCREW 16x120m

Facility

$8,315.00

Hospital Charge Code	270675557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.25
Max. Negotiated Rate	$4,157.50
Rate for Payer: Aetna Commercial	$2,494.50
Rate for Payer: Aetna Medicare Advantage	$2,494.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,120.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,120.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,120.32
Rate for Payer: Cigna Commercial	$4,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,012.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,247.25

STEM KNEE SMTH W/SCREW 16x120m

Facility

$8,315.00

Hospital Charge Code	270675557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.25
Max. Negotiated Rate	$2,012.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,663.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,012.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,247.25

STEM KNEE SMTH W/SCREW 16x80mm

Facility

$7,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270647560
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$1,844.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

STEM KNEE SMTH W/SCREW 16x80mm

Facility

$7,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270647560
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$3,810.00
Rate for Payer: Aetna Commercial	$2,286.00
Rate for Payer: Aetna Medicare Advantage	$2,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,943.10
Rate for Payer: Cigna Commercial	$3,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

STEM KNEE SMTH W/SCREW 18x80mm

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270669893
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$4,282.50
Rate for Payer: Aetna Commercial	$2,569.50
Rate for Payer: Aetna Medicare Advantage	$2,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,184.07
Rate for Payer: Cigna Commercial	$4,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

Know your out-of-pocket cost for care.

All Charges