Heights University Hospital

All Charges

Charge

Type

Setting

Price

LINER INSERT MDM X3 36MM C

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700713
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 INSERT MDM X3 36MM C

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700713
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 LONGEV DM BEAR 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270694354
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

LINER LONGEV DM BEAR 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270694354
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

LINER METAL BACK LARGE

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270680276
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$805.50
Rate for Payer: Aetna Medicare Advantage	$805.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.67
Rate for Payer: Cigna Commercial	$1,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

LINER METAL BACK LARGE

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270680276
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$649.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

LINER METAL BACK SMALL

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270672312
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$805.50
Rate for Payer: Aetna Medicare Advantage	$805.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.67
Rate for Payer: Cigna Commercial	$1,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

LINER METAL BACK SMALL

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270672312
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$649.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

LINER MOBILITY G7 DUAL 38MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688597
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 MOBILITY G7 DUAL 38MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688597
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 MULTIPOLAR PROV 50035028

Facility

$710.00

Hospital Charge Code	270637782
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$171.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.82
Rate for Payer: Qualcare PPO/HMO/WC	$106.50

LINER MULTIPOLAR PROV 50035028

Facility

$710.00

Hospital Charge Code	270637782
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$355.00
Rate for Payer: Aetna Commercial	$213.00
Rate for Payer: Aetna Medicare Advantage	$213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.05
Rate for Payer: Cigna Commercial	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.82
Rate for Payer: Qualcare PPO/HMO/WC	$106.50

LINER NEUTRAL 32 MM

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689639
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 NEUTRAL 32 MM

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689639
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 PLY XLPE 10DG 6310-46-28

Facility

$5,889.65

Hospital Charge Code	270635649
Hospital Revenue Code	278
Min. Negotiated Rate	$883.45
Max. Negotiated Rate	$2,944.82
Rate for Payer: Aetna Commercial	$1,766.89
Rate for Payer: Aetna Medicare Advantage	$1,766.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.86
Rate for Payer: Cigna Commercial	$2,944.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.30
Rate for Payer: Qualcare PPO/HMO/WC	$883.45

LINER PLY XLPE 10DG 6310-46-28

Facility

$5,889.65

Hospital Charge Code	270635649
Hospital Revenue Code	278
Min. Negotiated Rate	$883.45
Max. Negotiated Rate	$1,425.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.30
Rate for Payer: Qualcare PPO/HMO/WC	$883.45

LINER POLY 10DG 60x28 63106028

Facility

$5,654.60

Hospital Charge Code	270634430
Hospital Revenue Code	278
Min. Negotiated Rate	$848.19
Max. Negotiated Rate	$1,368.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,368.41
Rate for Payer: Qualcare PPO/HMO/WC	$848.19

LINER POLY 10DG 60x28 63106028

Facility

$5,654.60

Hospital Charge Code	270634430
Hospital Revenue Code	278
Min. Negotiated Rate	$848.19
Max. Negotiated Rate	$2,827.30
Rate for Payer: Aetna Commercial	$1,696.38
Rate for Payer: Aetna Medicare Advantage	$1,696.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,441.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,441.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,441.92
Rate for Payer: Cigna Commercial	$2,827.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,368.41
Rate for Payer: Qualcare PPO/HMO/WC	$848.19

LINER POLY STANDARD 0 PLUS

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689177
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$1,908.08
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER POLY STANDARD 0 PLUS

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689177
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER POLY STANDARD +3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689633
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER POLY STANDARD +3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689633
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$1,908.08
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER POLYX 10 DEG 60 63106028

Facility

$5,186.25

Hospital Charge Code	270630430
Hospital Revenue Code	278
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$2,593.12
Rate for Payer: Aetna Commercial	$1,555.88
Rate for Payer: Aetna Medicare Advantage	$1,555.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.49
Rate for Payer: Cigna Commercial	$2,593.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

LINER POLYX 10 DEG 60 63106028

Facility

$5,186.25

Hospital Charge Code	270630430
Hospital Revenue Code	278
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$1,255.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

LINER POLY XLPE 66x28 63106628

Facility

$5,186.25

Hospital Charge Code	270633433
Hospital Revenue Code	278
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$1,255.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

Know your out-of-pocket cost for care.

All Charges