Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSERT TBI TRIATHLON X3 CS 9MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270700102
Hospital Revenue Code	278
Min. Negotiated Rate	$762.36
Max. Negotiated Rate	$1,229.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: Qualcare PPO/HMO/WC	$762.36

INSERT TIBAL FX POST STAB SZ

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685506
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INSERT TIBAL FX POST STAB SZ

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685506
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INSERT TIB BEARING PS SZ2 9MM

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691994
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,495.58
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

INSERT TIB BEARING PS SZ2 9MM

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691994
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

INSERT TIBIAL 5 X14 RIGHT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678424
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL 5 X14 RIGHT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678424
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL 6-9 18 MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683943
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

INSERT TIBIAL 6-9 18 MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683943
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

INSERT TIBIAL ATTUNE PS 52 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687607
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL ATTUNE PS 52 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687604
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL ATTUNE PS 52 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687604
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL ATTUNE PS 52 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687607
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL ATTUNE SZ 7 5MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687593
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INSERT TIBIAL ATTUNE SZ 7 5MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687593
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INSERT TIBIAL FIXED SZ2 10MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676448
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL FIXED SZ2 10MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676448
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT TIBIAL FIXED SZ4 12MM

Facility

$5,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270676519
Hospital Revenue Code	278
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$1,415.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

INSERT TIBIAL FIXED SZ4 12MM

Facility

$5,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270676519
Hospital Revenue Code	278
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$2,925.00
Rate for Payer: Aetna Commercial	$1,755.00
Rate for Payer: Aetna Medicare Advantage	$1,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,491.75
Rate for Payer: Cigna Commercial	$2,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

INSERT TIBIAL FLEX SZ3 10MM RT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681584
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBIAL FLEX SZ3 10MM RT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681584
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBIAL FLEX SZ3 14MM RT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBIAL FLEX SZ3 14MM RT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBIAL FLEX SZ3 17MM LT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683758
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBIAL FLEX SZ3 17MM LT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683758
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges