Heights University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL PSN CCR NRW SZ7

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690107
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

FEMORAL PSN CMT CCR SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690102
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

FEMORAL PSN CMT CCR SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690102
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

FEMORAL PSN PS CMT SZ 8

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690742
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

FEMORAL PSN PS CMT SZ 8

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690742
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

FEMORAL PS OPEN BOX 60mm LEFT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646502
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$5,169.00
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS OPEN BOX 60mm LEFT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646502
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS OPEN BOX 62.5MM LFT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270677827
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$3,315.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 62.5MM LFT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270677827
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 65MM RT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270647013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 65MM RT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270647013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$3,315.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 67.5mm RT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646612
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$5,169.00
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS OPEN BOX 67.5mm RT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646612
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS OPEN BOX 75MM LEFT

Facility

$11,050.00

Hospital Charge Code	270676548
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 75MM LEFT

Facility

$11,050.00

Hospital Charge Code	270676548
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$3,315.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL P/S RIGHT 70 183112

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639712
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

FEMORAL P/S RIGHT 70 183112

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639712
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

FEMORAL PS TRIATHL SZ6 RT

Facility

$6,859.95

Service Code	HCPCS C1776
Hospital Charge Code	270691172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.99
Max. Negotiated Rate	$1,660.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.99

FEMORAL PS TRIATHL SZ6 RT

Facility

$6,859.95

Service Code	HCPCS C1776
Hospital Charge Code	270691172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.99
Max. Negotiated Rate	$3,429.97
Rate for Payer: Aetna Commercial	$2,057.99
Rate for Payer: Aetna Medicare Advantage	$2,057.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.29
Rate for Payer: Cigna Commercial	$3,429.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.99

FEMORAL RGT 70MM 145153

Facility

$13,312.70

Hospital Charge Code	270636513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,996.90
Max. Negotiated Rate	$6,656.35
Rate for Payer: Aetna Commercial	$3,993.81
Rate for Payer: Aetna Medicare Advantage	$3,993.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,662.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,394.74
Rate for Payer: Cigna Commercial	$6,656.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,221.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,996.90

FEMORAL RGT 70MM 145153

Facility

$13,312.70

Hospital Charge Code	270636513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,996.90
Max. Negotiated Rate	$3,221.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,662.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,221.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,996.90

FEMORAL RM 45 102100

Facility

$9,042.45

Hospital Charge Code	270632446
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.37
Max. Negotiated Rate	$4,521.23
Rate for Payer: Aetna Commercial	$2,712.74
Rate for Payer: Aetna Medicare Advantage	$2,712.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,305.82
Rate for Payer: Cigna Commercial	$4,521.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37

FEMORAL RM 45 102100

Facility

$9,042.45

Hospital Charge Code	270632446
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.37
Max. Negotiated Rate	$2,188.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37

FEMORAL RM 48 102110

Facility

$10,396.25

Hospital Charge Code	270630492
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.44
Max. Negotiated Rate	$2,515.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,515.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.44

FEMORAL RM 48 102110

Facility

$10,396.25

Hospital Charge Code	270630492
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.44
Max. Negotiated Rate	$5,198.12
Rate for Payer: Aetna Commercial	$3,118.88
Rate for Payer: Aetna Medicare Advantage	$3,118.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.04
Rate for Payer: Cigna Commercial	$5,198.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,515.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.44

Know your out-of-pocket cost for care.

All Charges