Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER GLENOID FOSSA TM 12MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696615
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270658159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270658159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT SM-R 4

Facility

$6,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270685178
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

SHOULDER GLENOID PEG TT SM-R 4

Facility

$6,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270685178
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$1,890.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685204
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685204
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOSPHERE 36MM

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270676750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

SHOULDER GLENOSPHERE 36MM

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270676750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$3,757.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

SHOULDER GLENOSPHERE SM-R

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270672169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$3,757.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

SHOULDER GLENOSPHERE SM-R

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270672169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

SHOULDER IMMOBILIZER LG

Facility

$33.25

Hospital Charge Code	270649542
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$9.97
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Oxford Commercial	$16.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$16.62

SHOULDER IMMOBILIZER LG

Facility

$33.25

Hospital Charge Code	270649542
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER IMMOBILIZER MEDIUM

Facility

$33.25

Hospital Charge Code	270649543
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$9.97
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Oxford Commercial	$16.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$16.62

SHOULDER IMMOBILIZER MEDIUM

Facility

$33.25

Hospital Charge Code	270649543
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER IMMOBILIZER SMALL

Facility

$33.25

Hospital Charge Code	270649544
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$9.97
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Oxford Commercial	$16.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$16.62

SHOULDER IMMOBILIZER SMALL

Facility

$33.25

Hospital Charge Code	270649544
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER IMMOBILIZER X-LARGE

Facility

$33.25

Hospital Charge Code	270649545
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$9.97
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Oxford Commercial	$16.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$16.62

SHOULDER IMMOBILIZER X-LARGE

Facility

$33.25

Hospital Charge Code	270649545
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER INSTRUMENT CASE

Facility

$5,250.00

Hospital Charge Code	270656562
Hospital Revenue Code	272
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

SHOULDER INSTRUMENT CASE

Facility

$5,250.00

Hospital Charge Code	270656562
Hospital Revenue Code	272
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$2,625.00

Know your out-of-pocket cost for care.

All Charges