Heights University Hospital

All Charges

Charge

Type

Setting

Price

SMOOTH PEG LOCKING 2.0X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664354
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

SMOOTH PEG LOCKING 2.0X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664354
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

SMOOTH PINS PAK

Facility

$1,432.75

Hospital Charge Code	270685072
Hospital Revenue Code	272
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$214.91
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

SMOOTH PINS PAK

Facility

$1,432.75

Hospital Charge Code	270685072
Hospital Revenue Code	272
Min. Negotiated Rate	$186.26
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$429.82
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.26
Rate for Payer: Oxford Commercial	$716.38
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Commercial	$716.38

SMR RT SHOULDER LINER SM

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270675949
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

SMR RT SHOULDER LINER SM

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270675949
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

SMR SHOULDER HUMERAL BODY

Facility

$9,955.00

Service Code	HCPCS C1776
Hospital Charge Code	270673175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.25
Max. Negotiated Rate	$4,977.50
Rate for Payer: Aetna Commercial	$2,986.50
Rate for Payer: Aetna Medicare Advantage	$2,986.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,538.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,538.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,991.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,538.53
Rate for Payer: Cigna Commercial	$4,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,409.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,493.25

SMR SHOULDER HUMERAL BODY

Facility

$9,955.00

Service Code	HCPCS C1776
Hospital Charge Code	270673175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.25
Max. Negotiated Rate	$2,409.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,991.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,409.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,493.25

SMR SHOULDER REVERSE LINER

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270673176
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

SMR SHOULDER REVERSE LINER

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270673176
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

SMR SHOULDER /SPALLA

Facility

$18,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678828
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$5,625.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

SMR SHOULDER /SPALLA

Facility

$18,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678828
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

SM & SM/RNP AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3000943
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

SM & SM/RNP AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3000943
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

SM UNI CEMENT RESTRICTOR W/DI

Facility

$927.00

Service Code	HCPCS C1776
Hospital Charge Code	270660305
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$224.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.33
Rate for Payer: Qualcare PPO/HMO/WC	$139.05

SM UNI CEMENT RESTRICTOR W/DI

Facility

$927.00

Service Code	HCPCS C1776
Hospital Charge Code	270660305
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$463.50
Rate for Payer: Aetna Commercial	$278.10
Rate for Payer: Aetna Medicare Advantage	$278.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.38
Rate for Payer: Cigna Commercial	$463.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.33
Rate for Payer: Qualcare PPO/HMO/WC	$139.05

SNAP COVER 36x28 0052013628

Facility

$5.85

Hospital Charge Code	270606705C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$1.75
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.76
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$2.92

SNAP COVER 36x28 0052013628

Facility

$5.85

Hospital Charge Code	270606705C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

SNAP COVER 48X65 5210EZ4865

Facility

$12.53

Hospital Charge Code	270609407C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

SNAP COVER 48X65 5210EZ4865

Facility

$12.53

Hospital Charge Code	270609407C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$6.26
Rate for Payer: Aetna Commercial	$3.76
Rate for Payer: Aetna Medicare Advantage	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.63
Rate for Payer: Oxford Commercial	$6.26
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$6.26

SNAP COVER 50X50 01-5050

Facility

$19.80

Hospital Charge Code	270606706C
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

SNAP COVER 50X50 01-5050

Facility

$19.80

Hospital Charge Code	270606706C
Hospital Revenue Code	272
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna Commercial	$5.94
Rate for Payer: Aetna Medicare Advantage	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.05
Rate for Payer: Cigna Commercial	$9.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.57
Rate for Payer: Oxford Commercial	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$9.90

SNAP-OFF FT PIN 1.9MMX12MM

Facility

$1,802.50

Hospital Charge Code	270703050
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$540.75
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

SNAP-OFF FT PIN 1.9MMX12MM

Facility

$1,802.50

Hospital Charge Code	270703050
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

SNAP-OFF PIN 1.9MMX14MM

Facility

$1,802.50

Hospital Charge Code	270703051
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$540.75
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

Know your out-of-pocket cost for care.

All Charges