Heights University Hospital

All Charges

Charge

Type

Setting

Price

LINER ACETAB 40SZ 25 EP108525

Facility

$9,265.00

Hospital Charge Code	270644875
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$2,779.50
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABLR 40 RLC EP108524

Facility

$9,265.00

Hospital Charge Code	270644635
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$2,779.50
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABLR 40 RLC EP108524

Facility

$9,265.00

Hospital Charge Code	270644635
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 15DEG. SZ G 3

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679648
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LINER ACETABULAR 15DEG. SZ G 3

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679648
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LINER ACETABULAR 22 32mm

Facility

$9,265.00

Hospital Charge Code	270644359
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$2,779.50
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 22 32mm

Facility

$9,265.00

Hospital Charge Code	270644359
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 28 MM SIZE 22

Facility

$5,765.00

Hospital Charge Code	270667967
Hospital Revenue Code	278
Min. Negotiated Rate	$864.75
Max. Negotiated Rate	$2,882.50
Rate for Payer: Aetna Commercial	$1,729.50
Rate for Payer: Aetna Medicare Advantage	$1,729.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,470.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,470.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,470.08
Rate for Payer: Cigna Commercial	$2,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,395.13
Rate for Payer: Qualcare PPO/HMO/WC	$864.75

LINER ACETABULAR 28 MM SIZE 22

Facility

$5,765.00

Hospital Charge Code	270667967
Hospital Revenue Code	278
Min. Negotiated Rate	$864.75
Max. Negotiated Rate	$1,395.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,395.13
Rate for Payer: Qualcare PPO/HMO/WC	$864.75

LINER ACETABULAR 36MM

Facility

$9,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270679048
Hospital Revenue Code	278
Min. Negotiated Rate	$1,443.75
Max. Negotiated Rate	$4,812.50
Rate for Payer: Aetna Commercial	$2,887.50
Rate for Payer: Aetna Medicare Advantage	$2,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,454.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,454.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,454.38
Rate for Payer: Cigna Commercial	$4,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,443.75

LINER ACETABULAR 36MM

Facility

$9,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270679048
Hospital Revenue Code	278
Min. Negotiated Rate	$1,443.75
Max. Negotiated Rate	$2,329.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,443.75

LINER ACETABULAR 36mm SIZE 24

Facility

$9,265.00

Hospital Charge Code	270645774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$2,779.50
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 36mm SIZE 24

Facility

$9,265.00

Hospital Charge Code	270645774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 36MM SZ 25

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270666901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 36MM SZ 25

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270666901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$2,779.50
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 40MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688349
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

LINER ACETABULAR 40MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688349
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

LINER ACETABULAR 44MM SZ F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677542
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

LINER ACETABULAR 44MM SZ F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677542
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

LINER ACETABULAR ALTEX 10 DEG

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689570
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

LINER ACETABULAR ALTEX 10 DEG

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689570
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

LINER ACETABULAR RINGLOC

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270659192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$2,779.50
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR RINGLOC

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270659192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETB G7 VITE HWAL 32MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LINER ACETB G7 VITE HWAL 32MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

Know your out-of-pocket cost for care.

All Charges