Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER LINER 3MM DIA 40MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270685175
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

SHOULDER LINER 3MM DIA 40MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270685175
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,545.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

SHOULDER METAL BACK GLEN. SM-R

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672172
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

SHOULDER METAL BACK GLEN. SM-R

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672172
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$1,806.00
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

SHOULDER MIN 2 VW-LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	94061289
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER MIN 2 VW-LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	94061289
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

SHOULDER MIN 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	94061291
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER MIN 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	94061291
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

SHOULDER MIN 2 VWS-BI

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	94061215
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER MIN 2 VWS-BI

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	94061215
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

SHOULDER MUMFORD PROC-

Facility

$50,586.00

Service Code	HCPCS 29824
Hospital Charge Code	16000228
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$15,175.80
Rate for Payer: Aetna Commercial	$15,175.80
Rate for Payer: Aetna Medicare Advantage	$15,175.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,899.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,899.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,899.43
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,576.18
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

SHOULDER MUMFORD PROC-

Facility

$50,586.00

Service Code	HCPCS 29824
Hospital Charge Code	16000228
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

SHOULDER POSITIONER

Facility

$125.00

Hospital Charge Code	270335714
Hospital Revenue Code	272
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

SHOULDER POSITIONER

Facility

$125.00

Hospital Charge Code	270335714
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SHOULDER REVERSE 38MM

Facility

$7,393.10

Service Code	HCPCS C1776
Hospital Charge Code	270668553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.96
Max. Negotiated Rate	$3,696.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.96
Rate for Payer: Aetna Commercial	$2,217.93
Rate for Payer: Aetna Medicare Advantage	$2,217.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,885.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,885.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,885.24
Rate for Payer: Cigna Commercial	$3,696.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.13

SHOULDER REVERSE 38MM

Facility

$7,393.10

Service Code	HCPCS C1776
Hospital Charge Code	270668553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.96
Max. Negotiated Rate	$1,789.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.96

SHOULDER REVERSE LINER +6MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270672164
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

SHOULDER REVERSE LINER +6MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270672164
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,545.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

SHOULDER REVERSE LINER STD

Facility

$3,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270672165
Hospital Revenue Code	278
Min. Negotiated Rate	$547.50
Max. Negotiated Rate	$1,825.00
Rate for Payer: Aetna Commercial	$1,095.00
Rate for Payer: Aetna Medicare Advantage	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.75
Rate for Payer: Cigna Commercial	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.30
Rate for Payer: Qualcare PPO/HMO/WC	$547.50

SHOULDER REVERSE LINER STD

Facility

$3,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270672165
Hospital Revenue Code	278
Min. Negotiated Rate	$547.50
Max. Negotiated Rate	$883.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.30
Rate for Payer: Qualcare PPO/HMO/WC	$547.50

SHOULDER SURGERY PROCEDURE

Facility

$859.60

Service Code	HCPCS 23929
Hospital Charge Code	16000546
Hospital Revenue Code	360
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$128.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.94

SHOULDER SURGERY PROCEDURE

Facility

$859.60

Service Code	HCPCS 23929
Hospital Charge Code	16000546
Hospital Revenue Code	360
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$257.88
Rate for Payer: Aetna Medicare Advantage	$257.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.20
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.75
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.94
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

SHOULDER SUSPENSION KIT

Facility

$279.00

Hospital Charge Code	270335485
Hospital Revenue Code	272
Min. Negotiated Rate	$36.27
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$83.70
Rate for Payer: Aetna Medicare Advantage	$83.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.14
Rate for Payer: Cigna Commercial	$139.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.27
Rate for Payer: Oxford Commercial	$139.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.85
Rate for Payer: UnitedHealthcare Commercial	$139.50

SHOULDER SUSPENSION KIT

Facility

$279.00

Hospital Charge Code	270335485
Hospital Revenue Code	272
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$41.85
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

SHOULDER TISSUE ELEVATOR 15

Facility

$1,550.00

Hospital Charge Code	270656564
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

Know your out-of-pocket cost for care.

All Charges