Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEM PSN REV 14 X 75 MM EXT

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270690106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.88
Max. Negotiated Rate	$2,824.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,334.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,824.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.88

STEM PSN REV 14 X 75 MM EXT

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270690106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.88
Max. Negotiated Rate	$5,836.25
Rate for Payer: Aetna Commercial	$3,501.75
Rate for Payer: Aetna Medicare Advantage	$3,501.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,976.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,976.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,334.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,976.49
Rate for Payer: Cigna Commercial	$5,836.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,824.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.88

STEM PSN REV 6MM OFFSET EXT 14

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694283
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

STEM PSN REV 6MM OFFSET EXT 14

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694283
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$5,655.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

STEM PSN REV ST SPLINE

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$3,738.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

STEM PSN REV ST SPLINE

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$7,725.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare Advantage	$4,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,939.75
Rate for Payer: Cigna Commercial	$7,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

STEM -P STD #1

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688765
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 -P STD #1

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688765
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 RADIAL ALIGN 8MM 2MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

STEM RADIAL ALIGN 8MM 2MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$3,450.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

STEM RADIAL ALIGN 9 MM X 0 MM

Facility

$9,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270678337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

STEM RADIAL ALIGN 9 MM X 0 MM

Facility

$9,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270678337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$4,887.50
Rate for Payer: Aetna Commercial	$2,932.50
Rate for Payer: Aetna Medicare Advantage	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,492.62
Rate for Payer: Cigna Commercial	$4,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

STEM RADIAL ALIGN 9MMx0MM

Facility

$9,775.00

Hospital Charge Code	270378337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

STEM RADIAL ALIGN 9MMx0MM

Facility

$9,775.00

Hospital Charge Code	270378337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$4,887.50
Rate for Payer: Aetna Commercial	$2,932.50
Rate for Payer: Aetna Medicare Advantage	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,492.62
Rate for Payer: Cigna Commercial	$4,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

STEM RADIAL ALIGN 9X4MM

Facility

$11,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270697687
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.25
Max. Negotiated Rate	$2,888.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.25

STEM RADIAL ALIGN 9X4MM

Facility

$11,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270697687
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.25
Max. Negotiated Rate	$5,967.50
Rate for Payer: Aetna Commercial	$3,580.50
Rate for Payer: Aetna Medicare Advantage	$3,580.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,043.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,043.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,043.43
Rate for Payer: Cigna Commercial	$5,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.25

STEM REVISION D 18MM x200 MM

Facility

$28,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682980
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$6,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

STEM REVISION D 18MM x200 MM

Facility

$28,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682980
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$14,000.00
Rate for Payer: Aetna Commercial	$8,400.00
Rate for Payer: Aetna Medicare Advantage	$8,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,140.00
Rate for Payer: Cigna Commercial	$14,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

STEM REV STR SPLINE 12 X 135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270690147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.94
Max. Negotiated Rate	$3,026.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94

STEM REV STR SPLINE 12 X 135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270690147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.94
Max. Negotiated Rate	$6,253.12
Rate for Payer: Aetna Commercial	$3,751.88
Rate for Payer: Aetna Medicare Advantage	$3,751.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.09
Rate for Payer: Cigna Commercial	$6,253.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94

STEM SECUREFIT SZ11 40MM

Facility

$11,937.80

Service Code	HCPCS C1776
Hospital Charge Code	270692257
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$5,968.90
Rate for Payer: Aetna Commercial	$3,581.34
Rate for Payer: Aetna Medicare Advantage	$3,581.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,044.14
Rate for Payer: Cigna Commercial	$5,968.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

STEM SECUREFIT SZ11 40MM

Facility

$11,937.80

Service Code	HCPCS C1776
Hospital Charge Code	270692257
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$2,888.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

STEM SECURE R FIT 127 #6

Facility

$11,937.80

Service Code	HCPCS C1776
Hospital Charge Code	270691975
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$5,968.90
Rate for Payer: Aetna Commercial	$3,581.34
Rate for Payer: Aetna Medicare Advantage	$3,581.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,044.14
Rate for Payer: Cigna Commercial	$5,968.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

STEM SECURE R FIT 127 #6

Facility

$11,937.80

Service Code	HCPCS C1776
Hospital Charge Code	270691975
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$2,888.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

STEM SECUR-FIT MAX 127 HIP #7

Facility

$11,662.80

Service Code	HCPCS C1776
Hospital Charge Code	270693033
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.42
Max. Negotiated Rate	$2,822.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,332.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.42

Know your out-of-pocket cost for care.

All Charges