Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSERT/REPLACE PG SN

Facility

$27,653.00

Service Code	HCPCS 33212
Hospital Charge Code	7411017
Hospital Revenue Code	480
Min. Negotiated Rate	$228.33
Max. Negotiated Rate	$19,706.96
Rate for Payer: Aetna Commercial	$8,295.90
Rate for Payer: Aetna Medicare Advantage	$8,295.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,051.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,051.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,051.52
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.89
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,147.95
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

INSERT/REPLACE PG SN

Facility

$27,653.00

Service Code	HCPCS 33212
Hospital Charge Code	366833212
Hospital Revenue Code	480
Min. Negotiated Rate	$228.33
Max. Negotiated Rate	$19,706.96
Rate for Payer: Aetna Commercial	$8,295.90
Rate for Payer: Aetna Medicare Advantage	$8,295.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,051.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,051.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,051.52
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.89
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,147.95
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

INSERT/REPLACE PG SN

Facility

$27,653.00

Service Code	HCPCS 33212
Hospital Charge Code	7411017
Hospital Revenue Code	480
Min. Negotiated Rate	$4,147.95
Max. Negotiated Rate	$4,147.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,147.95

INSERT/REPLACE PG SN

Facility

$27,653.00

Service Code	HCPCS 33212
Hospital Charge Code	366833212
Hospital Revenue Code	480
Min. Negotiated Rate	$4,147.95
Max. Negotiated Rate	$4,147.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,147.95

INSERT SELF CONTD PROSTHESIS

Facility

$94,818.00

Service Code	HCPCS 54401
Hospital Charge Code	1600000543
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$49,357.08
Rate for Payer: Aetna Commercial	$28,445.40
Rate for Payer: Aetna Medicare Advantage	$28,445.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,178.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,178.59
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	$24,178.59
Rate for Payer: Cigna Commercial	$49,357.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,326.34
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.70
Rate for Payer: UnitedHealthcare Commercial	$11,456.00

INSERT SELF CONTD PROSTHESIS

Facility

$94,818.00

Service Code	HCPCS 54401
Hospital Charge Code	1600000543
Hospital Revenue Code	360
Min. Negotiated Rate	$14,222.70
Max. Negotiated Rate	$14,222.70
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.70

INSERT SHOULDER RET

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270689836
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,545.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270689836
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET 3 MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270687800
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET 3 MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270687800
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,545.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET. +5MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270684267
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET. +5MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270684267
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,545.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHPERE FLEX LEFT 10MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684049
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SHPERE FLEX LEFT 10MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684049
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SINGLE PM LEAD

Facility

$15,108.00

Service Code	HCPCS 33216
Hospital Charge Code	7411027
Hospital Revenue Code	480
Min. Negotiated Rate	$2,266.20
Max. Negotiated Rate	$2,266.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,266.20

INSERT SINGLE PM LEAD

Facility

$15,108.00

Service Code	HCPCS 33216
Hospital Charge Code	366833216
Hospital Revenue Code	480
Min. Negotiated Rate	$2,266.20
Max. Negotiated Rate	$2,266.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,266.20

INSERT SINGLE PM LEAD

Facility

$15,108.00

Service Code	HCPCS 33216
Hospital Charge Code	366833216
Hospital Revenue Code	480
Min. Negotiated Rate	$282.90
Max. Negotiated Rate	$19,706.96
Rate for Payer: Aetna Better Health Medicaid	$961.87
Rate for Payer: Aetna Commercial	$4,532.40
Rate for Payer: Aetna Medicare Advantage	$4,532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,852.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,852.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,852.54
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,964.04
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,266.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$981.11

INSERT SINGLE PM LEAD

Facility

$15,108.00

Service Code	HCPCS 33216
Hospital Charge Code	7411027
Hospital Revenue Code	480
Min. Negotiated Rate	$282.90
Max. Negotiated Rate	$19,706.96
Rate for Payer: Aetna Better Health Medicaid	$961.87
Rate for Payer: Aetna Commercial	$4,532.40
Rate for Payer: Aetna Medicare Advantage	$4,532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,852.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,852.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,852.54
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,964.04
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,266.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$981.11

INSERT SPHERE FLEX 14MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681367
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 14MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681367
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 14 MM S2 LE

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684073
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 14 MM S2 LE

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684073
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 20 MM S3 L

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684074
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 20 MM S3 L

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684074
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 12MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683384
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges