Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHEET XMD SILASTIC 2X2 1532510

Facility

$83.00

Hospital Charge Code	270624855
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

SHELL

Facility

$8,660.65

Hospital Charge Code	270657085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

SHELL

Facility

$8,660.65

Hospital Charge Code	270657085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$2,598.20
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

SHELL3 HOLE 50MM

Facility

$15,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270688361
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$4,716.00
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL3 HOLE 50MM

Facility

$15,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270688361
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 FINNED 52E

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680806
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

SHELL 3 HOLE G7 FINNED 52E

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680806
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$1,950.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

SHELL 3 HOLE G7 OSSEOTI

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$4,716.00
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 OSSEOTI

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 OSSEOTI 52 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688345
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$4,716.00
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 3 HOLE G7 OSSEOTI 52 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688345
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL 52x38 M2A METAL RD118852

Facility

$14,235.25

Hospital Charge Code	270632847
Hospital Revenue Code	278
Min. Negotiated Rate	$2,135.29
Max. Negotiated Rate	$7,117.62
Rate for Payer: Aetna Commercial	$4,270.57
Rate for Payer: Aetna Medicare Advantage	$4,270.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,629.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,629.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,847.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,629.99
Rate for Payer: Cigna Commercial	$7,117.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,444.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,135.29

SHELL 52x38 M2A METAL RD118852

Facility

$14,235.25

Hospital Charge Code	270632847
Hospital Revenue Code	278
Min. Negotiated Rate	$2,135.29
Max. Negotiated Rate	$3,444.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,847.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,444.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,135.29

SHELL 54x38 M2A METAL RD118854

Facility

$13,178.45

Hospital Charge Code	270631463
Hospital Revenue Code	278
Min. Negotiated Rate	$1,976.77
Max. Negotiated Rate	$3,189.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,635.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,976.77

SHELL 54x38 M2A METAL RD118854

Facility

$13,178.45

Hospital Charge Code	270631463
Hospital Revenue Code	278
Min. Negotiated Rate	$1,976.77
Max. Negotiated Rate	$6,589.23
Rate for Payer: Aetna Commercial	$3,953.53
Rate for Payer: Aetna Medicare Advantage	$3,953.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,635.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,360.50
Rate for Payer: Cigna Commercial	$6,589.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,976.77

SHELL 60MM TRIDENT ACETABULAR

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270695458
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.22
Max. Negotiated Rate	$3,404.07
Rate for Payer: Aetna Commercial	$2,042.44
Rate for Payer: Aetna Medicare Advantage	$2,042.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.08
Rate for Payer: Cigna Commercial	$3,404.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,647.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.22

SHELL 60MM TRIDENT ACETABULAR

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270695458
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.22
Max. Negotiated Rate	$1,647.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,647.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.22

SHELL ACEBLR 52m CLUS 62005222

Facility

$5,996.10

Hospital Charge Code	270633332
Hospital Revenue Code	278
Min. Negotiated Rate	$899.41
Max. Negotiated Rate	$1,451.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.06
Rate for Payer: Qualcare PPO/HMO/WC	$899.41

SHELL ACEBLR 52m CLUS 62005222

Facility

$5,996.10

Hospital Charge Code	270633332
Hospital Revenue Code	278
Min. Negotiated Rate	$899.41
Max. Negotiated Rate	$2,998.05
Rate for Payer: Aetna Commercial	$1,798.83
Rate for Payer: Aetna Medicare Advantage	$1,798.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,529.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,529.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,529.01
Rate for Payer: Cigna Commercial	$2,998.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.06
Rate for Payer: Qualcare PPO/HMO/WC	$899.41

SHELL ACET 48mm OD 6200-48-22

Facility

$5,467.25

Hospital Charge Code	270630439
Hospital Revenue Code	278
Min. Negotiated Rate	$820.09
Max. Negotiated Rate	$1,323.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: Qualcare PPO/HMO/WC	$820.09

SHELL ACET 48mm OD 6200-48-22

Facility

$5,467.25

Hospital Charge Code	270630439
Hospital Revenue Code	278
Min. Negotiated Rate	$820.09
Max. Negotiated Rate	$2,733.62
Rate for Payer: Aetna Commercial	$1,640.17
Rate for Payer: Aetna Medicare Advantage	$1,640.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,394.15
Rate for Payer: Cigna Commercial	$2,733.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: Qualcare PPO/HMO/WC	$820.09

SHELL ACET 56mmOD 6200-50-22

Facility

$5,467.25

Hospital Charge Code	270631620
Hospital Revenue Code	278
Min. Negotiated Rate	$820.09
Max. Negotiated Rate	$1,323.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: Qualcare PPO/HMO/WC	$820.09

SHELL ACET 56mmOD 6200-50-22

Facility

$5,467.25

Hospital Charge Code	270631620
Hospital Revenue Code	278
Min. Negotiated Rate	$820.09
Max. Negotiated Rate	$2,733.62
Rate for Payer: Aetna Commercial	$1,640.17
Rate for Payer: Aetna Medicare Advantage	$1,640.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,394.15
Rate for Payer: Cigna Commercial	$2,733.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: Qualcare PPO/HMO/WC	$820.09

SHELL ACET 66mm CLUST 62006622

Facility

$5,186.25

Hospital Charge Code	270633434
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

SHELL ACET 66mm CLUST 62006622

Facility

$5,186.25

Hospital Charge Code	270633434
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

Know your out-of-pocket cost for care.

All Charges