Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSN FEM PS POR CCR NRW SZ6

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695671
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ12 R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694198
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ12 R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694198
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PSPOR CCRSTD SZ6 R

Facility

$27,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270694858
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

PSN FEM PSPOR CCRSTD SZ6 R

Facility

$27,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270694858
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$8,242.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

PSN FEM PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693727
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696396
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693727
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696396
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ9 L

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR STD SZ9 L

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR SZ7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696123
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR CCR SZ7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696123
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR STD SZ 10

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694593
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS POR STD SZ 10

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694593
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM TIB FIXED KEEL SZ R

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

PSN FEM TIB FIXED KEEL SZ R

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$5,546.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

PSN F SCREW 25MM

Facility

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	270691313
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$203.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.28
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

PSN F SCREW 25MM

Facility

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	270691313
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial	$252.00
Rate for Payer: Aetna Medicare Advantage	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.28
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

PSN FSM PS POR CCR STD SZ 8

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696052
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$9,261.00
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FSM PS POR CCR STD SZ 8

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696052
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN INSERT TIB BEARING 10MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695437
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN INSERT TIB BEARING 10MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695437
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN LIN TIBIAL INS 12MM CR8-11

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694749
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN LIN TIBIAL INS 12MM CR8-11

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694749
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

Know your out-of-pocket cost for care.

All Charges