Heights University Hospital

All Charges

Charge

Type

Setting

Price

LINER ACETBULAR 36 MM

Facility

$6,000.00

Hospital Charge Code	270703304
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LINER ACETBULAR 36 MM

Facility

$6,000.00

Hospital Charge Code	270703304
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LINER ACETEBULAR SIZE 25 36mm

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270639963
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 ACETEBULAR SIZE 25 36mm

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270639963
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

LINERACETTRIDENTTRX3PE0D40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697850
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$2,217.12
Rate for Payer: Aetna Commercial	$1,330.28
Rate for Payer: Aetna Medicare Advantage	$1,330.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,130.73
Rate for Payer: Cigna Commercial	$2,217.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

LINERACETTRIDENTTRX3PE0D40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697850
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$1,073.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

LINER ACTBLR 36 SZ23 EP-108323

Facility

$9,265.00

Hospital Charge Code	270658421
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 ACTBLR 36 SZ23 EP-108323

Facility

$9,265.00

Hospital Charge Code	270658421
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 ARCOM 32mm RING LOC

Facility

$4,330.00

Hospital Charge Code	270638891
Hospital Revenue Code	278
Min. Negotiated Rate	$649.50
Max. Negotiated Rate	$2,165.00
Rate for Payer: Aetna Commercial	$1,299.00
Rate for Payer: Aetna Medicare Advantage	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.15
Rate for Payer: Cigna Commercial	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: Qualcare PPO/HMO/WC	$649.50

LINER ARCOM 32mm RING LOC

Facility

$4,330.00

Hospital Charge Code	270638891
Hospital Revenue Code	278
Min. Negotiated Rate	$649.50
Max. Negotiated Rate	$1,047.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: Qualcare PPO/HMO/WC	$649.50

LINER ARCOM XL 24mm RINGLOC

Facility

$5,728.85

Hospital Charge Code	270636664
Hospital Revenue Code	278
Min. Negotiated Rate	$859.33
Max. Negotiated Rate	$1,386.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,386.38
Rate for Payer: Qualcare PPO/HMO/WC	$859.33

LINER ARCOM XL 24mm RINGLOC

Facility

$5,728.85

Hospital Charge Code	270636664
Hospital Revenue Code	278
Min. Negotiated Rate	$859.33
Max. Negotiated Rate	$2,864.43
Rate for Payer: Aetna Commercial	$1,718.65
Rate for Payer: Aetna Medicare Advantage	$1,718.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,460.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,460.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,460.86
Rate for Payer: Cigna Commercial	$2,864.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,386.38
Rate for Payer: Qualcare PPO/HMO/WC	$859.33

LINER ARCOM XL 28mm RINGLOC

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270634778
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

LINER ARCOM XL 28mm RINGLOC

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270634778
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

LINER ARC XL36mm RING XL105914

Facility

$5,775.00

Hospital Charge Code	270637576
Hospital Revenue Code	278
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$1,397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

LINER ARC XL36mm RING XL105914

Facility

$5,775.00

Hospital Charge Code	270637576
Hospital Revenue Code	278
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$1,732.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

LINER ASF 16MM VE RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689751
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LINER ASF 16MM VE RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689751
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LINER ASSY 40/41x22ID 50014022

Facility

$1,528.50

Hospital Charge Code	270633291
Hospital Revenue Code	278
Min. Negotiated Rate	$229.28
Max. Negotiated Rate	$764.25
Rate for Payer: Aetna Commercial	$458.55
Rate for Payer: Aetna Medicare Advantage	$458.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$389.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$389.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$389.77
Rate for Payer: Cigna Commercial	$764.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.90
Rate for Payer: Qualcare PPO/HMO/WC	$229.28

LINER ASSY 40/41x22ID 50014022

Facility

$1,528.50

Hospital Charge Code	270633291
Hospital Revenue Code	278
Min. Negotiated Rate	$229.28
Max. Negotiated Rate	$369.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.90
Rate for Payer: Qualcare PPO/HMO/WC	$229.28

LINER ASSY 42/43x22 50014222

Facility

$1,400.00

Hospital Charge Code	270633232
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$338.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.80
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

LINER ASSY 42/43x22 50014222

Facility

$1,400.00

Hospital Charge Code	270633232
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$420.00
Rate for Payer: Aetna Medicare Advantage	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.00
Rate for Payer: Cigna Commercial	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.80
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

LINER BMT ACET 22 28 11-105902

Facility

$4,881.65

Hospital Charge Code	270615805
Hospital Revenue Code	278
Min. Negotiated Rate	$732.25
Max. Negotiated Rate	$1,181.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.36
Rate for Payer: Qualcare PPO/HMO/WC	$732.25

LINER BMT ACET 22 28 11-105902

Facility

$4,881.65

Hospital Charge Code	270615805
Hospital Revenue Code	278
Min. Negotiated Rate	$732.25
Max. Negotiated Rate	$2,440.82
Rate for Payer: Aetna Commercial	$1,464.49
Rate for Payer: Aetna Medicare Advantage	$1,464.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.82
Rate for Payer: Cigna Commercial	$2,440.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.36
Rate for Payer: Qualcare PPO/HMO/WC	$732.25

LINER BMT ACET 23 11-105903

Facility

$4,520.85

Hospital Charge Code	270606919
Hospital Revenue Code	278
Min. Negotiated Rate	$678.13
Max. Negotiated Rate	$1,094.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.05
Rate for Payer: Qualcare PPO/HMO/WC	$678.13

Know your out-of-pocket cost for care.

All Charges