Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACETAB 58 SZ 25 16104158

Facility

$7,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270644876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.75
Max. Negotiated Rate	$1,927.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75

SHELL ACETAB 58 SZ 25 16104158

Facility

$7,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270644876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.75
Max. Negotiated Rate	$3,982.50
Rate for Payer: Aetna Commercial	$2,389.50
Rate for Payer: Aetna Medicare Advantage	$2,389.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,031.08
Rate for Payer: Cigna Commercial	$3,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75

SHELL ACETAB CLUST TRIDENT 62G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$2,973.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

SHELL ACETAB CLUST TRIDENT 62G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$6,143.75
Rate for Payer: Aetna Commercial	$3,686.25
Rate for Payer: Aetna Medicare Advantage	$3,686.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,133.31
Rate for Payer: Cigna Commercial	$6,143.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

SHELL ACETAB DM MPACT DIA 60

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694021
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB DM MPACT DIA 60

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694021
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB LTD G7PPS

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690736
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 ACETAB LTD G7PPS

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690736
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 ACETAB MPAC 54

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB MPAC 54

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB MPACT DOUBLE MOB

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB MPACT DOUBLE MOB

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB MPACT MULTI 60

Facility

$16,695.00

Service Code	HCPCS C1776
Hospital Charge Code	270694022
Hospital Revenue Code	278
Min. Negotiated Rate	$2,504.25
Max. Negotiated Rate	$8,347.50
Rate for Payer: Aetna Commercial	$5,008.50
Rate for Payer: Aetna Medicare Advantage	$5,008.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,257.23
Rate for Payer: Cigna Commercial	$8,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25

SHELL ACETAB MPACT MULTI 60

Facility

$16,695.00

Service Code	HCPCS C1776
Hospital Charge Code	270694022
Hospital Revenue Code	278
Min. Negotiated Rate	$2,504.25
Max. Negotiated Rate	$4,040.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25

SHELL ACETAB TRIDENT II 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697068
Hospital Revenue Code	278
Min. Negotiated Rate	$883.34
Max. Negotiated Rate	$2,944.47
Rate for Payer: Aetna Commercial	$1,766.68
Rate for Payer: Aetna Medicare Advantage	$1,766.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.68
Rate for Payer: Cigna Commercial	$2,944.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: Qualcare PPO/HMO/WC	$883.34

SHELL ACETAB TRIDENT II 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697068
Hospital Revenue Code	278
Min. Negotiated Rate	$883.34
Max. Negotiated Rate	$1,425.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: Qualcare PPO/HMO/WC	$883.34

SHELL ACETAB TRITANIUM II 58MM

Facility

$5,858.55

Service Code	HCPCS C1776
Hospital Charge Code	270697927
Hospital Revenue Code	278
Min. Negotiated Rate	$878.78
Max. Negotiated Rate	$1,417.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,417.77
Rate for Payer: Qualcare PPO/HMO/WC	$878.78

SHELL ACETAB TRITANIUM II 58MM

Facility

$5,858.55

Service Code	HCPCS C1776
Hospital Charge Code	270697927
Hospital Revenue Code	278
Min. Negotiated Rate	$878.78
Max. Negotiated Rate	$2,929.28
Rate for Payer: Aetna Commercial	$1,757.57
Rate for Payer: Aetna Medicare Advantage	$1,757.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,493.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,493.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,493.93
Rate for Payer: Cigna Commercial	$2,929.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,417.77
Rate for Payer: Qualcare PPO/HMO/WC	$878.78

SHELL ACETABULAR 3-HOLE 48mm

Facility

$5,550.00

Hospital Charge Code	270644360
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

SHELL ACETABULAR 3-HOLE 48mm

Facility

$5,550.00

Hospital Charge Code	270644360
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$1,665.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

SHELL ACETABULAR 50 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688348
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 ACETABULAR 50 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688348
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 ACETABULAR 50MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	2706883482
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 ACETABULAR 50MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	2706883482
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 ACETABULAR 50mm SIZE 23

Facility

$9,235.00

Hospital Charge Code	270646477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.25
Max. Negotiated Rate	$4,617.50
Rate for Payer: Aetna Commercial	$2,770.50
Rate for Payer: Aetna Medicare Advantage	$2,770.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,354.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,354.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,354.93
Rate for Payer: Cigna Commercial	$4,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,234.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,385.25

Know your out-of-pocket cost for care.

All Charges