Heights University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR HEAD 47MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676219
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 47MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676219
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 49MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675841
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 49MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675841
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 50MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675416
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 50MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675416
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD COMP UNIV 44X28MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697701
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$1,411.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

BIPOLAR HEAD COMP UNIV 44X28MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697701
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$2,916.65
Rate for Payer: Aetna Commercial	$1,749.99
Rate for Payer: Aetna Medicare Advantage	$1,749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,487.49
Rate for Payer: Cigna Commercial	$2,916.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

BI-POLAR HEAD SELF CENTERING

Facility

$6,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270663840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$3,385.00
Rate for Payer: Aetna Commercial	$2,031.00
Rate for Payer: Aetna Medicare Advantage	$2,031.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,726.35
Rate for Payer: Cigna Commercial	$3,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

BI-POLAR HEAD SELF CENTERING

Facility

$6,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270663840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$1,638.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

BIPOLAR HEAD SZ 42MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675406
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD SZ 42MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675406
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD SZ 44MM HEAD 2

Facility

$14,695.00

Hospital Charge Code	270667793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,204.25
Max. Negotiated Rate	$3,556.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,939.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,556.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,204.25

BIPOLAR HEAD SZ 44MM HEAD 2

Facility

$14,695.00

Hospital Charge Code	270667793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,204.25
Max. Negotiated Rate	$7,347.50
Rate for Payer: Aetna Commercial	$4,408.50
Rate for Payer: Aetna Medicare Advantage	$4,408.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,747.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,747.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,939.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,747.22
Rate for Payer: Cigna Commercial	$7,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,556.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,204.25

BIPOLAR HIP REPLACEMENT

Facility

$15,113.50

Service Code	HCPCS 27236
Hospital Charge Code	16000869
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$4,534.05
Rate for Payer: Aetna Medicare Advantage	$4,534.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,853.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,853.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,853.94
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,964.76
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,267.03
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

BIPOLAR HIP REPLACEMENT

Facility

$15,113.50

Service Code	HCPCS 27236
Hospital Charge Code	16000869
Hospital Revenue Code	360
Min. Negotiated Rate	$2,267.03
Max. Negotiated Rate	$2,267.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,267.03

BIPOLAR LINER

Facility

$1,437.55

Hospital Charge Code	270656965
Hospital Revenue Code	278
Min. Negotiated Rate	$215.63
Max. Negotiated Rate	$718.77
Rate for Payer: Aetna Commercial	$431.26
Rate for Payer: Aetna Medicare Advantage	$431.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.58
Rate for Payer: Cigna Commercial	$718.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: Qualcare PPO/HMO/WC	$215.63

BIPOLAR LINER

Facility

$1,437.55

Hospital Charge Code	270656965
Hospital Revenue Code	278
Min. Negotiated Rate	$215.63
Max. Negotiated Rate	$347.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: Qualcare PPO/HMO/WC	$215.63

BIPOLAR LINER 42/43 OD X 22MM

Facility

$1,437.55

Hospital Charge Code	270665069
Hospital Revenue Code	278
Min. Negotiated Rate	$215.63
Max. Negotiated Rate	$347.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: Qualcare PPO/HMO/WC	$215.63

BIPOLAR LINER 42/43 OD X 22MM

Facility

$1,437.55

Hospital Charge Code	270665069
Hospital Revenue Code	278
Min. Negotiated Rate	$215.63
Max. Negotiated Rate	$718.77
Rate for Payer: Aetna Commercial	$431.26
Rate for Payer: Aetna Medicare Advantage	$431.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.58
Rate for Payer: Cigna Commercial	$718.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: Qualcare PPO/HMO/WC	$215.63

BIPOLAR MARYLAND SINGLE SITE

Facility

$1,283.33

Hospital Charge Code	270672906
Hospital Revenue Code	272
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$192.50

BIPOLAR MARYLAND SINGLE SITE

Facility

$1,283.33

Hospital Charge Code	270672906
Hospital Revenue Code	272
Min. Negotiated Rate	$166.83
Max. Negotiated Rate	$641.66
Rate for Payer: Aetna Commercial	$385.00
Rate for Payer: Aetna Medicare Advantage	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$327.25
Rate for Payer: Cigna Commercial	$641.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.83
Rate for Payer: Oxford Commercial	$641.66
Rate for Payer: Qualcare PPO/HMO/WC	$192.50
Rate for Payer: UnitedHealthcare Commercial	$641.66

BIPOLAR SHELL 42MM OD

Facility

$2,256.50

Hospital Charge Code	270665068
Hospital Revenue Code	278
Min. Negotiated Rate	$338.48
Max. Negotiated Rate	$1,128.25
Rate for Payer: Aetna Commercial	$676.95
Rate for Payer: Aetna Medicare Advantage	$676.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.41
Rate for Payer: Cigna Commercial	$1,128.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.07
Rate for Payer: Qualcare PPO/HMO/WC	$338.48

BIPOLAR SHELL 42MM OD

Facility

$2,256.50

Hospital Charge Code	270665068
Hospital Revenue Code	278
Min. Negotiated Rate	$338.48
Max. Negotiated Rate	$546.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.07
Rate for Payer: Qualcare PPO/HMO/WC	$338.48

BIPOLAR TRIGGER FLEA 40 CM PRB

Facility

$3,750.00

Hospital Charge Code	270688728
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$1,875.00

Know your out-of-pocket cost for care.

All Charges