Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$4,386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

PSN REV CCK ART 14 MM 3-5

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$3,738.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

PSN REV CCK ART 14 MM 3-5

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$7,725.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare Advantage	$4,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,939.75
Rate for Payer: Cigna Commercial	$7,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

PSNREVCCKARTSRFVE10MMRT11-13GH

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697637
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSRFVE10MMRT11-13GH

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697637
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697458
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697458
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MMR11-13EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699726
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MMR11-13EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699726
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE12MML3-5CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696395
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE12MML3-5CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696395
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSN REV CCK ART SURF VE 12MM R

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSN REV CCK ART SURF VE 12MM R

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697667
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697667
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697460
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697460
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSN REV CCK ART SURF VE 18MM L

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696797
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSN REV CCK ART SURF VE 18MM L

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696797
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$5,600.62
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSN REV CCK VE 12MM L 11-13 GH

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695149
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

PSN REV CCK VE 12MM L 11-13 GH

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695149
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$4,386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

PSN REV FEM CMT CCR PLS SZ3

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694073
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$13,378.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PLS SZ3

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694073
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$27,640.62
Rate for Payer: Aetna Commercial	$16,584.38
Rate for Payer: Aetna Medicare Advantage	$16,584.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,096.72
Rate for Payer: Cigna Commercial	$27,640.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PLS SZ 3L

Facility

$727.20

Service Code	HCPCS C1776
Hospital Charge Code	270699862
Hospital Revenue Code	278
Min. Negotiated Rate	$109.08
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna Commercial	$218.16
Rate for Payer: Aetna Medicare Advantage	$218.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.44
Rate for Payer: Cigna Commercial	$363.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08

PSN REV FEM CMT CCR PLS SZ 3L

Facility

$727.20

Service Code	HCPCS C1776
Hospital Charge Code	270699862
Hospital Revenue Code	278
Min. Negotiated Rate	$109.08
Max. Negotiated Rate	$175.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08

Know your out-of-pocket cost for care.

All Charges