Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACETABULAR SECTOR 64MM

Facility

$7,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.12
Max. Negotiated Rate	$1,715.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.12

SHELL ACETABULAR SECTOR 64MM

Facility

$7,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.12
Max. Negotiated Rate	$3,543.75
Rate for Payer: Aetna Commercial	$2,126.25
Rate for Payer: Aetna Medicare Advantage	$2,126.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,807.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,807.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,807.31
Rate for Payer: Cigna Commercial	$3,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.12

SHELL ACETABULAR SZ 22 52mm

Facility

$4,500.00

Hospital Charge Code	270664060
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SHELL ACETABULAR SZ 22 52mm

Facility

$4,500.00

Hospital Charge Code	270664060
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SHELL ACETABULATE HOLE 54x23mm

Facility

$11,790.00

Service Code	HCPCS C1776
Hospital Charge Code	270679674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.50
Max. Negotiated Rate	$2,853.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,853.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,768.50

SHELL ACETABULATE HOLE 54x23mm

Facility

$11,790.00

Service Code	HCPCS C1776
Hospital Charge Code	270679674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.50
Max. Negotiated Rate	$5,895.00
Rate for Payer: Aetna Commercial	$3,537.00
Rate for Payer: Aetna Medicare Advantage	$3,537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,006.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,006.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,358.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,006.45
Rate for Payer: Cigna Commercial	$5,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,853.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,768.50

SHELL ACETABULR 3H 62 CP158127

Facility

$10,090.00

Hospital Charge Code	270641541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.50
Max. Negotiated Rate	$5,045.00
Rate for Payer: Aetna Commercial	$3,027.00
Rate for Payer: Aetna Medicare Advantage	$3,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,572.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,572.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,572.95
Rate for Payer: Cigna Commercial	$5,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50

SHELL ACETABULR 3H 62 CP158127

Facility

$10,090.00

Hospital Charge Code	270641541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.50
Max. Negotiated Rate	$2,441.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50

SHELL ACET LTD G7 PPS 60 G

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SHELL ACET LTD G7 PPS 60 G

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SHELL ACET LTD PPS G7 50 MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689753
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 ACET LTD PPS G7 50 MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689753
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 ACET OSSEO TI SZ3 50MM

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270679688
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$9,495.00
Rate for Payer: Aetna Commercial	$5,697.00
Rate for Payer: Aetna Medicare Advantage	$5,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,842.45
Rate for Payer: Cigna Commercial	$9,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELL ACET OSSEO TI SZ3 50MM

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270679688
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELL ACET TI SOLID 54MM SZ E

Facility

$5,671.60

Service Code	HCPCS C1776
Hospital Charge Code	270692155
Hospital Revenue Code	278
Min. Negotiated Rate	$850.74
Max. Negotiated Rate	$1,372.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.53
Rate for Payer: Qualcare PPO/HMO/WC	$850.74

SHELL ACET TI SOLID 54MM SZ E

Facility

$5,671.60

Service Code	HCPCS C1776
Hospital Charge Code	270692155
Hospital Revenue Code	278
Min. Negotiated Rate	$850.74
Max. Negotiated Rate	$2,835.80
Rate for Payer: Aetna Commercial	$1,701.48
Rate for Payer: Aetna Medicare Advantage	$1,701.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,446.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,446.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,446.26
Rate for Payer: Cigna Commercial	$2,835.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.53
Rate for Payer: Qualcare PPO/HMO/WC	$850.74

SHELL ACET TRILOGY 54 62005422

Facility

$5,996.10

Hospital Charge Code	270633726
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 ACET TRILOGY 54 62005422

Facility

$5,996.10

Hospital Charge Code	270633726
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 TRITAN 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697069
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 ACET TRITAN 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697069
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 ACET TRY 60 CLT 62006022

Facility

$5,991.75

Hospital Charge Code	270634431
Hospital Revenue Code	278
Min. Negotiated Rate	$898.76
Max. Negotiated Rate	$2,995.88
Rate for Payer: Aetna Commercial	$1,797.53
Rate for Payer: Aetna Medicare Advantage	$1,797.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,527.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,527.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,198.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,527.90
Rate for Payer: Cigna Commercial	$2,995.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$898.76

SHELL ACET TRY 60 CLT 62006022

Facility

$5,991.75

Hospital Charge Code	270634431
Hospital Revenue Code	278
Min. Negotiated Rate	$898.76
Max. Negotiated Rate	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,198.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$898.76

SHELL ACTBLR 54 RAN/BUR 106054

Facility

$4,761.65

Hospital Charge Code	270617514
Hospital Revenue Code	278
Min. Negotiated Rate	$714.25
Max. Negotiated Rate	$2,380.82
Rate for Payer: Aetna Commercial	$1,428.49
Rate for Payer: Aetna Medicare Advantage	$1,428.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,214.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,214.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$952.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,214.22
Rate for Payer: Cigna Commercial	$2,380.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,152.32
Rate for Payer: Qualcare PPO/HMO/WC	$714.25

SHELL ACTBLR 54 RAN/BUR 106054

Facility

$4,761.65

Hospital Charge Code	270617514
Hospital Revenue Code	278
Min. Negotiated Rate	$714.25
Max. Negotiated Rate	$1,152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$952.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,152.32
Rate for Payer: Qualcare PPO/HMO/WC	$714.25

SHELL AT 3 58mm HD RD CP158125

Facility

$10,090.00

Hospital Charge Code	270639959
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.50
Max. Negotiated Rate	$2,441.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50

Know your out-of-pocket cost for care.

All Charges