Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

LINER PRIME ECLASS LIPPED 36MM

Facility

$3,415.00

Service Code	HCPCS C1776
Hospital Charge Code	270697654
Hospital Revenue Code	278
Min. Negotiated Rate	$512.25
Max. Negotiated Rate	$1,707.50
Rate for Payer: Aetna Commercial	$1,024.50
Rate for Payer: Aetna Medicare Advantage	$1,024.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$870.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$870.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$870.83
Rate for Payer: Cigna Commercial	$1,707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.43
Rate for Payer: Qualcare PPO/HMO/WC	$512.25

LINER PRIME ECLASS LIPPED 36MM

Facility

$3,415.00

Service Code	HCPCS C1776
Hospital Charge Code	270697654
Hospital Revenue Code	278
Min. Negotiated Rate	$512.25
Max. Negotiated Rate	$826.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.43
Rate for Payer: Qualcare PPO/HMO/WC	$512.25

LINER PSN POLY PLY 38 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690743
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

LINER PSN POLY PLY 38 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690743
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

LINER RINGLOC ACETEBULAR 32MM

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270637438
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 RINGLOC ACETEBULAR 32MM

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270637438
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 RSS HXL STD 9S

Facility

$6,532.75

Service Code	HCPCS C1776
Hospital Charge Code	270691443
Hospital Revenue Code	278
Min. Negotiated Rate	$979.91
Max. Negotiated Rate	$1,580.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.93
Rate for Payer: Qualcare PPO/HMO/WC	$979.91

LINER RSS HXL STD 9S

Facility

$6,532.75

Service Code	HCPCS C1776
Hospital Charge Code	270691443
Hospital Revenue Code	278
Min. Negotiated Rate	$979.91
Max. Negotiated Rate	$3,266.38
Rate for Payer: Aetna Commercial	$1,959.83
Rate for Payer: Aetna Medicare Advantage	$1,959.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.85
Rate for Payer: Cigna Commercial	$3,266.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.93
Rate for Payer: Qualcare PPO/HMO/WC	$979.91

LINER RSS STD 6S PLUS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691072
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

LINER RSS STD 6S PLUS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691072
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$1,928.61
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

LINER SIZE 3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688878
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 SIZE 3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688878
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 SIZE 9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689175
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 SIZE 9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689175
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

LINERS SUCTION RECEPTACLE****

Facility

$1.00

Hospital Charge Code	8001026
Hospital Revenue Code	279
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

LINERS SUCTION RECEPTACLE****

Facility

$1.00

Hospital Charge Code	8001026
Hospital Revenue Code	279
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

LINER STANDARD +3S RSS

Facility

$6,423.70

Service Code	HCPCS C1776
Hospital Charge Code	270690995
Hospital Revenue Code	278
Min. Negotiated Rate	$963.55
Max. Negotiated Rate	$3,211.85
Rate for Payer: Aetna Commercial	$1,927.11
Rate for Payer: Aetna Medicare Advantage	$1,927.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.04
Rate for Payer: Cigna Commercial	$3,211.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.54
Rate for Payer: Qualcare PPO/HMO/WC	$963.55

LINER STANDARD +3S RSS

Facility

$6,423.70

Service Code	HCPCS C1776
Hospital Charge Code	270690995
Hospital Revenue Code	278
Min. Negotiated Rate	$963.55
Max. Negotiated Rate	$1,554.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.54
Rate for Payer: Qualcare PPO/HMO/WC	$963.55

LINER STANDARD 9

Facility

$5,279.20

Service Code	HCPCS C1776
Hospital Charge Code	270689618
Hospital Revenue Code	278
Min. Negotiated Rate	$791.88
Max. Negotiated Rate	$2,639.60
Rate for Payer: Aetna Commercial	$1,583.76
Rate for Payer: Aetna Medicare Advantage	$1,583.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.20
Rate for Payer: Cigna Commercial	$2,639.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.57
Rate for Payer: Qualcare PPO/HMO/WC	$791.88

LINER STANDARD 9

Facility

$5,279.20

Service Code	HCPCS C1776
Hospital Charge Code	270689618
Hospital Revenue Code	278
Min. Negotiated Rate	$791.88
Max. Negotiated Rate	$1,277.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.57
Rate for Payer: Qualcare PPO/HMO/WC	$791.88

LINER STD FACE 36x23mm

Facility

$14,045.00

Hospital Charge Code	270675922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.75
Max. Negotiated Rate	$3,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75

LINER STD FACE 36x23mm

Facility

$14,045.00

Hospital Charge Code	270675922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.75
Max. Negotiated Rate	$7,022.50
Rate for Payer: Aetna Commercial	$4,213.50
Rate for Payer: Aetna Medicare Advantage	$4,213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,581.47
Rate for Payer: Cigna Commercial	$7,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75

LINER STD F/METAL BACK GLENOID

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270675411
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

LINER STD F/METAL BACK GLENOID

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270675411
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

Know your out-of-pocket cost for care.

All Charges