Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$5,831.40
Rate for Payer: Aetna Commercial	$3,498.84
Rate for Payer: Aetna Medicare Advantage	$3,498.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,332.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.01
Rate for Payer: Cigna Commercial	$5,831.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.42

STEM SECURFIT SZ11 40MM 170MM

Facility

$11,449.40

Service Code	HCPCS C1776
Hospital Charge Code	270694831
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.41
Max. Negotiated Rate	$5,724.70
Rate for Payer: Aetna Commercial	$3,434.82
Rate for Payer: Aetna Medicare Advantage	$3,434.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,289.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.60
Rate for Payer: Cigna Commercial	$5,724.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.41

STEM SECURFIT SZ11 40MM 170MM

Facility

$11,449.40

Service Code	HCPCS C1776
Hospital Charge Code	270694831
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.41
Max. Negotiated Rate	$2,770.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,289.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.41

STEM SECUR MAX 127 DEG #8

Facility

$11,937.80

Service Code	HCPCS C1776
Hospital Charge Code	270692080
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 MAX 127 DEG #8

Facility

$11,937.80

Service Code	HCPCS C1776
Hospital Charge Code	270692080
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 SHORT HUMERAL 10SZ

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691232
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STEM SHORT HUMERAL 10SZ

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691232
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STEM, SHOULDER RESURF. DIA. 11

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270680384
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STEM, SHOULDER RESURF. DIA. 11

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270680384
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STEM SMOOTH 14x80MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270677285
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

STEM SMOOTH 14x80MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270677285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$2,072.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

STEM SMOOTH BIO 18 X 40 MM

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270692923
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 SMOOTH BIO 18 X 40 MM

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270692923
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 SMR 16 MM X 150MM

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682890
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STEM SMR 16 MM X 150MM

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682890
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STEM SMR SHOULDER 13 L X 36MM

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270679033
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STEM SMR SHOULDER 13 L X 36MM

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270679033
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STEM SMR SHOULDER 13x150MM

Facility

$11,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270677040
Hospital Revenue Code	278
Min. Negotiated Rate	$1,747.50
Max. Negotiated Rate	$5,825.00
Rate for Payer: Aetna Commercial	$3,495.00
Rate for Payer: Aetna Medicare Advantage	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,970.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,970.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,970.75
Rate for Payer: Cigna Commercial	$5,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,819.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,747.50

STEM SMR SHOULDER 13x150MM

Facility

$11,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270677040
Hospital Revenue Code	278
Min. Negotiated Rate	$1,747.50
Max. Negotiated Rate	$2,819.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,819.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,747.50

STEM SMR SHOULDER 13x180MM

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677334
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STEM SMR SHOULDER 13x180MM

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677334
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STEM SPHERE CEMENTED LEFT S4+

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681127
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 SPHERE CEMENTED LEFT S4+

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681127
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 STD 11MM X 122MM LONG

Facility

$21,545.00

Service Code	HCPCS C1776
Hospital Charge Code	270668583
Hospital Revenue Code	278
Min. Negotiated Rate	$3,231.75
Max. Negotiated Rate	$5,213.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,213.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,231.75

STEM STD 11MM X 122MM LONG

Facility

$21,545.00

Service Code	HCPCS C1776
Hospital Charge Code	270668583
Hospital Revenue Code	278
Min. Negotiated Rate	$3,231.75
Max. Negotiated Rate	$10,772.50
Rate for Payer: Aetna Commercial	$6,463.50
Rate for Payer: Aetna Medicare Advantage	$6,463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,493.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,493.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,309.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,493.98
Rate for Payer: Cigna Commercial	$10,772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,213.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,231.75

Know your out-of-pocket cost for care.

All Charges