Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIAGABINE TAB 12MG

Facility

$11.25

Hospital Charge Code	60629021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

TIAGABINE TAB 12MG

Facility

$11.25

Hospital Charge Code	60629021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

TIAGABINE TAB 16MG

Facility

$20.85

Hospital Charge Code	60628774
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

TIAGABINE TAB 16MG

Facility

$20.85

Hospital Charge Code	60628774
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$6.25
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$10.43

TI ALIF SA SPACER 10X34X24 15D

Facility

$33,125.00

Hospital Charge Code	270703553
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$9,937.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

TI ALIF SA SPACER 10X34X24 15D

Facility

$33,125.00

Hospital Charge Code	270703553
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25

TIBAL KNEE BASE FX BEARING SZ

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685508
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

TIBAL KNEE BASE FX BEARING SZ

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685508
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

TIBAL MODULAR

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270679530
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

TIBAL MODULAR

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270679530
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$1,665.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

TIB BEARING INSERT CS 11MM SZ4

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270692376
Hospital Revenue Code	278
Min. Negotiated Rate	$781.35
Max. Negotiated Rate	$2,604.50
Rate for Payer: Aetna Commercial	$1,562.70
Rate for Payer: Aetna Medicare Advantage	$1,562.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.30
Rate for Payer: Cigna Commercial	$2,604.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.58
Rate for Payer: Qualcare PPO/HMO/WC	$781.35

TIB BEARING INSERT CS 11MM SZ4

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270692376
Hospital Revenue Code	278
Min. Negotiated Rate	$781.35
Max. Negotiated Rate	$1,260.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.58
Rate for Payer: Qualcare PPO/HMO/WC	$781.35

TIB BEARING INSET CS SZ 4 13MM

Facility

$5,336.50

Service Code	HCPCS C1776
Hospital Charge Code	270690855
Hospital Revenue Code	278
Min. Negotiated Rate	$800.48
Max. Negotiated Rate	$2,668.25
Rate for Payer: Aetna Commercial	$1,600.95
Rate for Payer: Aetna Medicare Advantage	$1,600.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,360.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,360.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,067.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,360.81
Rate for Payer: Cigna Commercial	$2,668.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,291.43
Rate for Payer: Qualcare PPO/HMO/WC	$800.48

TIB BEARING INSET CS SZ 4 13MM

Facility

$5,336.50

Service Code	HCPCS C1776
Hospital Charge Code	270690855
Hospital Revenue Code	278
Min. Negotiated Rate	$800.48
Max. Negotiated Rate	$1,291.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,067.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,291.43
Rate for Payer: Qualcare PPO/HMO/WC	$800.48

TIB BEARING VNGRD PS 63/67X10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679834
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

TIB BEARING VNGRD PS 63/67X10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679834
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

TIB BEARNG E1 VANGARD 71/75/10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679849
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

TIB BEARNG E1 VANGARD 71/75/10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679849
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

TIB BRG VNGRD SSK PSC20X71/75

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679831
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

TIB BRG VNGRD SSK PSC20X71/75

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679831
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$3,564.00
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

TIBETRACH SZ 4 LOW PR C

Facility

$573.65

Hospital Charge Code	270302380
Hospital Revenue Code	272
Min. Negotiated Rate	$74.57
Max. Negotiated Rate	$286.82
Rate for Payer: Aetna Commercial	$172.09
Rate for Payer: Aetna Medicare Advantage	$172.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.28
Rate for Payer: Cigna Commercial	$286.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.57
Rate for Payer: Oxford Commercial	$286.82
Rate for Payer: Qualcare PPO/HMO/WC	$86.05
Rate for Payer: UnitedHealthcare Commercial	$286.82

TIBETRACH SZ 4 LOW PR C

Facility

$573.65

Hospital Charge Code	270302380
Hospital Revenue Code	272
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$86.05
Rate for Payer: Qualcare PPO/HMO/WC	$86.05

TIB/FIB 2 VWS-BILAT

Facility

$6,601.19

Service Code	HCPCS 7359050
Hospital Charge Code	94061243
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

TIB/FIB 2 VWS-BILAT

Facility

$6,601.19

Service Code	HCPCS 7359050
Hospital Charge Code	94061243
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

TIB/FIB 2 VWS-LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	94061377
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

Know your out-of-pocket cost for care.

All Charges