Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSN MC VE ASF L 11MM 8-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699913
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 MC VE ASF L 11MM 8-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699913
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 MC VE ASF L 11MM 8-11 GH

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270699910
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

PSN MC VE ASF L 11MM 8-11 GH

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270699910
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$1,854.00
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

PSN MC VE ASF L 12MM 12/GH

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698909
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 MC VE ASF L 12MM 12/GH

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698909
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 MC VE ASF L 16MM 8-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694797
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 MC VE ASF L 16MM 8-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694797
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 MC VE ASF R 13MM 8-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695091
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 MC VE ASF R 13MM 8-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695091
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 MC VE ASF R 14MM 8-11 GH

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270694234
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PSN MC VE ASF R 14MM 8-11 GH

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270694234
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,539.00
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PSN MC VE ASF R 14MM 8-9 CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698698
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 MC VE ASF R 14MM 8-9 CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698698
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 NAT TIBIA TM SZ C

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695785
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN NAT TIBIA TM SZ C

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695785
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$4,149.00
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSNREV3MMOFFSETSTEMEXT13X135MM

Facility

$19,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270697461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.50
Max. Negotiated Rate	$4,702.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50

PSNREV3MMOFFSETSTEMEXT13X135MM

Facility

$19,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270697461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.50
Max. Negotiated Rate	$9,715.00
Rate for Payer: Aetna Commercial	$5,829.00
Rate for Payer: Aetna Medicare Advantage	$5,829.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,954.65
Rate for Payer: Cigna Commercial	$9,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50

PSN REV 3MM OFFSET STEM EXT 14

Facility

$19,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270700240
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.50
Max. Negotiated Rate	$4,702.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50

PSN REV 3MM OFFSET STEM EXT 14

Facility

$19,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270700240
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.50
Max. Negotiated Rate	$9,715.00
Rate for Payer: Aetna Commercial	$5,829.00
Rate for Payer: Aetna Medicare Advantage	$5,829.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,954.65
Rate for Payer: Cigna Commercial	$9,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50

PSN REV 3 OFFSET STEM EXTENS

Facility

$19,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270697606
Hospital Revenue Code	278
Min. Negotiated Rate	$2,916.75
Max. Negotiated Rate	$9,722.50
Rate for Payer: Aetna Commercial	$5,833.50
Rate for Payer: Aetna Medicare Advantage	$5,833.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,958.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,958.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,889.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,958.48
Rate for Payer: Cigna Commercial	$9,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,705.69
Rate for Payer: Qualcare PPO/HMO/WC	$2,916.75

PSN REV 3 OFFSET STEM EXTENS

Facility

$19,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270697606
Hospital Revenue Code	278
Min. Negotiated Rate	$2,916.75
Max. Negotiated Rate	$4,705.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,889.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,705.69
Rate for Payer: Qualcare PPO/HMO/WC	$2,916.75

PSN REV 6MM OFFSET EXT 13X135M

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694284
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

PSN REV 6MM OFFSET EXT 13X135M

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694284
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$5,655.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

PSN REV ART SURF VE EF 20MM

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270694635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$5,437.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

Know your out-of-pocket cost for care.

All Charges