Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLENOID FOSS LNR TM REV 36MM

Facility

$5,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270696096
Hospital Revenue Code	278
Min. Negotiated Rate	$783.75
Max. Negotiated Rate	$1,264.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: Qualcare PPO/HMO/WC	$783.75

GLENOID FOSS LNR TM REV 36MM

Facility

$5,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270696096
Hospital Revenue Code	278
Min. Negotiated Rate	$783.75
Max. Negotiated Rate	$2,612.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,332.38
Rate for Payer: Cigna Commercial	$2,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: Qualcare PPO/HMO/WC	$783.75

GLENOID FOSS TM RES SPACER 9MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696097
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

GLENOID FOSS TM RES SPACER 9MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696097
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$1,543.75
Rate for Payer: Aetna Commercial	$926.25
Rate for Payer: Aetna Medicare Advantage	$926.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.31
Rate for Payer: Cigna Commercial	$1,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

GLENOID GUIDE PIN 2.5MM

Facility

$750.00

Hospital Charge Code	270704576
Hospital Revenue Code	279
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$375.00

GLENOID GUIDE PIN 2.5MM

Facility

$750.00

Hospital Charge Code	270704576
Hospital Revenue Code	279
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GLENOID, HEAD58-54MM

Facility

$8,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270687340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$2,047.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

GLENOID, HEAD58-54MM

Facility

$8,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270687340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$4,230.00
Rate for Payer: Aetna Commercial	$2,538.00
Rate for Payer: Aetna Medicare Advantage	$2,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,157.30
Rate for Payer: Cigna Commercial	$4,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

GLENOID METAL BACK LARGE

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270680275
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK LARGE

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270680275
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$1,806.00
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK SMALL

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672311
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK SMALL

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672311
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$1,806.00
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK STANDARD

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270675412
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$3,757.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

GLENOID METAL BACK STANDARD

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270675412
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

GLENOID MOD 4 PEG SZ4

Facility

$8,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270699889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

GLENOID MOD 4 PEG SZ4

Facility

$8,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270699889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$2,415.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

GLENOID MOD AUGMNT 4PEG LT SZ3

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270699472
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$862.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

GLENOID MOD AUGMNT 4PEG LT SZ3

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270699472
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

GLENOID PEGD MED 4 BIOM 113872

Facility

$4,900.50

Hospital Charge Code	270632548
Hospital Revenue Code	272
Min. Negotiated Rate	$735.08
Max. Negotiated Rate	$735.08
Rate for Payer: Qualcare PPO/HMO/WC	$735.08

GLENOID PEGD MED 4 BIOM 113872

Facility

$4,900.50

Hospital Charge Code	270632548
Hospital Revenue Code	272
Min. Negotiated Rate	$637.07
Max. Negotiated Rate	$2,450.25
Rate for Payer: Aetna Commercial	$1,470.15
Rate for Payer: Aetna Medicare Advantage	$1,470.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.63
Rate for Payer: Cigna Commercial	$2,450.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$637.07
Rate for Payer: Oxford Commercial	$2,450.25
Rate for Payer: Qualcare PPO/HMO/WC	$735.08
Rate for Payer: UnitedHealthcare Commercial	$2,450.25

GLENOID PEGGED BF 52MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683030
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GLENOID PEGGED BF 52MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683030
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GLENOID PEGGED CEMENTED MED

Facility

$4,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270669867
Hospital Revenue Code	278
Min. Negotiated Rate	$735.75
Max. Negotiated Rate	$2,452.50
Rate for Payer: Aetna Commercial	$1,471.50
Rate for Payer: Aetna Medicare Advantage	$1,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,250.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,250.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,250.78
Rate for Payer: Cigna Commercial	$2,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,187.01
Rate for Payer: Qualcare PPO/HMO/WC	$735.75

GLENOID PEGGED CEMENTED MED

Facility

$4,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270669867
Hospital Revenue Code	278
Min. Negotiated Rate	$735.75
Max. Negotiated Rate	$1,187.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,187.01
Rate for Payer: Qualcare PPO/HMO/WC	$735.75

GLENOID PEG SM MEDIUM

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270688089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

Know your out-of-pocket cost for care.

All Charges