Heights University Hospital

All Charges

Charge

Type

Setting

Price

SHELL GRIPTON 50MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL GRIPTON 50MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL GRIPTON 52MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL GRIPTON 52MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL HEMI SOLID BACK 52MM

Facility

$12,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270679082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,866.75
Max. Negotiated Rate	$6,222.50
Rate for Payer: Aetna Commercial	$3,733.50
Rate for Payer: Aetna Medicare Advantage	$3,733.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,173.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,173.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,173.47
Rate for Payer: Cigna Commercial	$6,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,011.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.75

SHELL HEMI SOLID BACK 52MM

Facility

$12,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270679082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,866.75
Max. Negotiated Rate	$3,011.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,011.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.75

SHELL HEMI SOLID BACK 54MM

Facility

$12,447.50

Service Code	HCPCS C1776
Hospital Charge Code	270678862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.12
Max. Negotiated Rate	$3,012.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.12

SHELL HEMI SOLID BACK 54MM

Facility

$12,447.50

Service Code	HCPCS C1776
Hospital Charge Code	270678862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.12
Max. Negotiated Rate	$6,223.75
Rate for Payer: Aetna Commercial	$3,734.25
Rate for Payer: Aetna Medicare Advantage	$3,734.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,174.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,174.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,174.11
Rate for Payer: Cigna Commercial	$6,223.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.12

SHELL HEMI SOLID BACK 58MM

Facility

$5,754.90

Hospital Charge Code	270677483
Hospital Revenue Code	278
Min. Negotiated Rate	$863.24
Max. Negotiated Rate	$1,392.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,392.69
Rate for Payer: Qualcare PPO/HMO/WC	$863.24

SHELL HEMI SOLID BACK 58MM

Facility

$5,754.90

Hospital Charge Code	270677483
Hospital Revenue Code	278
Min. Negotiated Rate	$863.24
Max. Negotiated Rate	$2,877.45
Rate for Payer: Aetna Commercial	$1,726.47
Rate for Payer: Aetna Medicare Advantage	$1,726.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,467.50
Rate for Payer: Cigna Commercial	$2,877.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,392.69
Rate for Payer: Qualcare PPO/HMO/WC	$863.24

SHELL LORDOT H11 FLHWK 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696183
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$5,925.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

SHELL LORDOT H11 FLHWK 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696183
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

SHELL LORDOTIC 29 MM TI 9 DEG

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270692917
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$5,692.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELL LORDOTIC 29 MM TI 9 DEG

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270692917
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELL M2A 60x54 US157860

Facility

$16,195.00

Hospital Charge Code	270638624
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$8,097.50
Rate for Payer: Aetna Commercial	$4,858.50
Rate for Payer: Aetna Medicare Advantage	$4,858.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,129.73
Rate for Payer: Cigna Commercial	$8,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

SHELL M2A 60x54 US157860

Facility

$16,195.00

Hospital Charge Code	270638624
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$3,919.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

SHELL MALLORY RADIAL 12104160

Facility

$6,477.85

Hospital Charge Code	270631108
Hospital Revenue Code	278
Min. Negotiated Rate	$971.68
Max. Negotiated Rate	$3,238.93
Rate for Payer: Aetna Commercial	$1,943.36
Rate for Payer: Aetna Medicare Advantage	$1,943.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.85
Rate for Payer: Cigna Commercial	$3,238.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.64
Rate for Payer: Qualcare PPO/HMO/WC	$971.68

SHELL MALLORY RADIAL 12104160

Facility

$6,477.85

Hospital Charge Code	270631108
Hospital Revenue Code	278
Min. Negotiated Rate	$971.68
Max. Negotiated Rate	$1,567.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.64
Rate for Payer: Qualcare PPO/HMO/WC	$971.68

SHELL MALLORY RADIAL 3HOL 50mm

Facility

$6,530.00

Hospital Charge Code	270638890
Hospital Revenue Code	278
Min. Negotiated Rate	$979.50
Max. Negotiated Rate	$1,580.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.26
Rate for Payer: Qualcare PPO/HMO/WC	$979.50

SHELL MALLORY RADIAL 3HOL 50mm

Facility

$6,530.00

Hospital Charge Code	270638890
Hospital Revenue Code	278
Min. Negotiated Rate	$979.50
Max. Negotiated Rate	$3,265.00
Rate for Payer: Aetna Commercial	$1,959.00
Rate for Payer: Aetna Medicare Advantage	$1,959.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.15
Rate for Payer: Cigna Commercial	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.26
Rate for Payer: Qualcare PPO/HMO/WC	$979.50

SHELL MALLORY RADIAL 3HOL 52mm

Facility

$6,530.00

Hospital Charge Code	270633517
Hospital Revenue Code	278
Min. Negotiated Rate	$979.50
Max. Negotiated Rate	$1,580.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.26
Rate for Payer: Qualcare PPO/HMO/WC	$979.50

SHELL MALLORY RADIAL 3HOL 52mm

Facility

$6,530.00

Hospital Charge Code	270633517
Hospital Revenue Code	278
Min. Negotiated Rate	$979.50
Max. Negotiated Rate	$3,265.00
Rate for Payer: Aetna Commercial	$1,959.00
Rate for Payer: Aetna Medicare Advantage	$1,959.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.15
Rate for Payer: Cigna Commercial	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.26
Rate for Payer: Qualcare PPO/HMO/WC	$979.50

SHELL MALLORY RADIAL 3HOL 58mm

Facility

$6,477.85

Hospital Charge Code	270633497
Hospital Revenue Code	278
Min. Negotiated Rate	$971.68
Max. Negotiated Rate	$3,238.93
Rate for Payer: Aetna Commercial	$1,943.36
Rate for Payer: Aetna Medicare Advantage	$1,943.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.85
Rate for Payer: Cigna Commercial	$3,238.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.64
Rate for Payer: Qualcare PPO/HMO/WC	$971.68

SHELL MALLORY RADIAL 3HOL 58mm

Facility

$6,477.85

Hospital Charge Code	270633497
Hospital Revenue Code	278
Min. Negotiated Rate	$971.68
Max. Negotiated Rate	$1,567.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.64
Rate for Payer: Qualcare PPO/HMO/WC	$971.68

SHELL MALY RADL 3H 54 12104154

Facility

$6,530.00

Hospital Charge Code	270632929
Hospital Revenue Code	278
Min. Negotiated Rate	$979.50
Max. Negotiated Rate	$3,265.00
Rate for Payer: Aetna Commercial	$1,959.00
Rate for Payer: Aetna Medicare Advantage	$1,959.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.15
Rate for Payer: Cigna Commercial	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.26
Rate for Payer: Qualcare PPO/HMO/WC	$979.50

Know your out-of-pocket cost for care.

All Charges