Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

GLENOID PEG SPALLA S/STD SHORT

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270673213
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 PEG SPALLA S/STD SHORT

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270673213
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 POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687834
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687834
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687833
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687833
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAX SCREW 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704873
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAX SCREW 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704873
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID RASP

Facility

$1,725.00

Hospital Charge Code	270656517
Hospital Revenue Code	278
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$417.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.45
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

GLENOID RASP

Facility

$1,725.00

Hospital Charge Code	270656517
Hospital Revenue Code	278
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$517.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.45
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

GLENOIDSPHERE 039X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$5,325.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOIDSPHERE 039X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOIDSPHERE 042X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699525
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOIDSPHERE 042X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699525
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$5,325.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOIDSPHERE 36X24.5

Facility

$125.00

Service Code	HCPCS C1776
Hospital Charge Code	270691236
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOIDSPHERE 36X24.5

Facility

$125.00

Service Code	HCPCS C1776
Hospital Charge Code	270691236
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID TM MOD POST TI-6AI-4V

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270699509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$2,011.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

GLENOID TM MOD POST TI-6AI-4V

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270699509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Commercial	$2,493.00
Rate for Payer: Aetna Medicare Advantage	$2,493.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,119.05
Rate for Payer: Cigna Commercial	$4,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

GLENOSPERE 3MM 36MM

Facility

$7,680.00

Service Code	HCPCS C1776
Hospital Charge Code	270671286
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$1,858.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

GLENOSPERE 3MM 36MM

Facility

$7,680.00

Service Code	HCPCS C1776
Hospital Charge Code	270671286
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$3,840.00
Rate for Payer: Aetna Commercial	$2,304.00
Rate for Payer: Aetna Medicare Advantage	$2,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,958.40
Rate for Payer: Cigna Commercial	$3,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

GLENOSPHERE #110030776

Facility

$9,750.00

Hospital Charge Code	270702534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$2,925.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GLENOSPHERE #110030776

Facility

$9,750.00

Hospital Charge Code	270702534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270689173
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$6,254.62
Rate for Payer: Aetna Commercial	$3,752.78
Rate for Payer: Aetna Medicare Advantage	$3,752.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.86
Rate for Payer: Cigna Commercial	$6,254.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270689173
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$3,027.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

Know your out-of-pocket cost for care.

All Charges