Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSN TIB POR 2 PEG SZ G R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694199
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 TIB POR 2 PEG SZ G R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694199
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

PSN TIB POR 2 PEG SZ H L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270698699
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

PSN TIB POR 2 PEG SZ H L

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270698699
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 TIB POR PEG SZ E R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695090
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 TIB POR PEG SZ E R

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270695090
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

PSN TIB REV TM CTL CONE SZ MED

Facility

$37,156.25

Service Code	HCPCS C1776
Hospital Charge Code	270695264
Hospital Revenue Code	278
Min. Negotiated Rate	$5,573.44
Max. Negotiated Rate	$8,991.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,431.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,991.81
Rate for Payer: Qualcare PPO/HMO/WC	$5,573.44

PSN TIB REV TM CTL CONE SZ MED

Facility

$37,156.25

Service Code	HCPCS C1776
Hospital Charge Code	270695264
Hospital Revenue Code	278
Min. Negotiated Rate	$5,573.44
Max. Negotiated Rate	$18,578.12
Rate for Payer: Aetna Commercial	$11,146.88
Rate for Payer: Aetna Medicare Advantage	$11,146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,474.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,474.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,431.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,474.84
Rate for Payer: Cigna Commercial	$18,578.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,991.81
Rate for Payer: Qualcare PPO/HMO/WC	$5,573.44

PSN TIB STM 5 DEG SZ C R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690018
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ C R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690018
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5DEG SZ D L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691311
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 TIB STM 5DEG SZ D L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691311
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 TIB STM 5 DEG SZ E L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686933
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ E L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686933
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ F L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689624
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ F L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689624
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ GR

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689745
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TIB STM 5 DEG SZ GR

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689745
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PSN TRAB METAL PS CCR SZ11

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693240
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 TRAB METAL PS CCR SZ11

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693240
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

PS+ TIBIAL BEARING 63/67MM 10M

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679664
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

PS+ TIBIAL BEARING 63/67MM 10M

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679664
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

PST-SIX MINUTE WALK TEST

Facility

$445.45

Service Code	HCPCS 94620
Hospital Charge Code	9500551
Hospital Revenue Code	460
Min. Negotiated Rate	$57.91
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$133.63
Rate for Payer: Aetna Medicare Advantage	$133.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.59
Rate for Payer: Cigna Commercial	$222.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.82
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PST-SIX MINUTE WALK TEST

Facility

$445.45

Service Code	HCPCS 94620
Hospital Charge Code	9500551
Hospital Revenue Code	460
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$66.82
Rate for Payer: Qualcare PPO/HMO/WC	$66.82

PSW10151

Facility

$20,190.00

Hospital Charge Code	270655996
Hospital Revenue Code	272
Min. Negotiated Rate	$3,028.50
Max. Negotiated Rate	$3,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,028.50

Know your out-of-pocket cost for care.

All Charges