Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEM PLASMA DISTAL 12x127MM

Facility

$28,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270675958
Hospital Revenue Code	278
Min. Negotiated Rate	$4,263.00
Max. Negotiated Rate	$14,210.00
Rate for Payer: Aetna Commercial	$8,526.00
Rate for Payer: Aetna Medicare Advantage	$8,526.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,247.10
Rate for Payer: Cigna Commercial	$14,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,877.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,263.00

STEM PLASMA DISTAL 12x127MM

Facility

$28,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270675958
Hospital Revenue Code	278
Min. Negotiated Rate	$4,263.00
Max. Negotiated Rate	$6,877.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,877.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,263.00

STEM POROCOAT STAND SZ8 107MM

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270685582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$5,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50
Rate for Payer: Aetna Commercial	$3,315.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10

STEM POROCOAT STAND SZ8 107MM

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270685582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

STEM POROUS 11mm INTEGRAL LAT-

Facility

$19,180.00

Hospital Charge Code	270670961
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 POROUS 11mm INTEGRAL LAT-

Facility

$19,180.00

Hospital Charge Code	270670961
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 POROUS 12mm INTEGRAL LAT-

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270636129
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 POROUS 12mm INTEGRAL LAT-

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270636129
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 POROUS 12mm X11-170315

Facility

$19,915.00

Hospital Charge Code	270643984
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 POROUS 12mm X11-170315

Facility

$19,915.00

Hospital Charge Code	270643984
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 POROUS 13 INTEG X11170313

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270635321
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 POROUS 13 INTEG X11170313

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270635321
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 POROUS 9mm X 125mm COLLAR

Facility

$19,180.00

Hospital Charge Code	270646033
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 POROUS 9mm X 125mm COLLAR

Facility

$19,180.00

Hospital Charge Code	270646033
Hospital Revenue Code	278
Min. Negotiated Rate	$2,877.00
Max. Negotiated Rate	$4,641.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,877.00
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

STEM POROUS 9MMx125MM PROXIMAL

Facility

$19,180.00

Hospital Charge Code	270648760
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 POROUS 9MMx125MM PROXIMAL

Facility

$19,180.00

Hospital Charge Code	270648760
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 POROUS BOWED 14.5x150MM

Facility

$10,515.00

Service Code	HCPCS C1776
Hospital Charge Code	270673719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,577.25
Max. Negotiated Rate	$2,544.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.25

STEM POROUS BOWED 14.5x150MM

Facility

$10,515.00

Service Code	HCPCS C1776
Hospital Charge Code	270673719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,577.25
Max. Negotiated Rate	$5,257.50
Rate for Payer: Aetna Commercial	$3,154.50
Rate for Payer: Aetna Medicare Advantage	$3,154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,681.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,681.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,681.32
Rate for Payer: Cigna Commercial	$5,257.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.25

STEM POROUS INTEGRAL

Facility

$19,180.00

Hospital Charge Code	270660355
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 POROUS INTEGRAL

Facility

$19,180.00

Hospital Charge Code	270660355
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 PORS INGL 16X160 11170316

Facility

$19,175.45

Hospital Charge Code	270634576
Hospital Revenue Code	278
Min. Negotiated Rate	$2,876.32
Max. Negotiated Rate	$4,640.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,835.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,876.32

STEM PORS INGL 16X160 11170316

Facility

$19,175.45

Hospital Charge Code	270634576
Hospital Revenue Code	278
Min. Negotiated Rate	$2,876.32
Max. Negotiated Rate	$9,587.73
Rate for Payer: Aetna Commercial	$5,752.64
Rate for Payer: Aetna Medicare Advantage	$5,752.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,889.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,889.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,835.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,889.74
Rate for Payer: Cigna Commercial	$9,587.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,876.32

STEM PRESSFIT 10 MM

Facility

$9,535.50

Service Code	HCPCS C1776
Hospital Charge Code	270688858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,430.33
Max. Negotiated Rate	$2,307.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,907.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,307.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,430.33

STEM PRESSFIT 10 MM

Facility

$9,535.50

Service Code	HCPCS C1776
Hospital Charge Code	270688858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,430.33
Max. Negotiated Rate	$4,767.75
Rate for Payer: Aetna Commercial	$2,860.65
Rate for Payer: Aetna Medicare Advantage	$2,860.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,431.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,431.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,907.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,431.55
Rate for Payer: Cigna Commercial	$4,767.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,307.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,430.33

STEM PRESS FIT SZ 13 TSS

Facility

$9,535.50

Service Code	HCPCS C1776
Hospital Charge Code	270689214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,430.33
Max. Negotiated Rate	$2,307.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,907.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,307.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,430.33

Know your out-of-pocket cost for care.

All Charges