Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIA INS MP EVO CS 12MM SZ5RT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

TIBIA INS MP EVO CS 12MM SZ5RT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698345
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

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	698345
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

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698345
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

TIBIA INST PSN ASF VE6-9 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	698345
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

TIBIAL 146550

Facility

$2,872.00

Hospital Charge Code	270609693
Hospital Revenue Code	278
Min. Negotiated Rate	$430.80
Max. Negotiated Rate	$695.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.02
Rate for Payer: Qualcare PPO/HMO/WC	$430.80

TIBIAL 146550

Facility

$2,872.00

Hospital Charge Code	270609693
Hospital Revenue Code	278
Min. Negotiated Rate	$430.80
Max. Negotiated Rate	$1,436.00
Rate for Payer: Aetna Commercial	$861.60
Rate for Payer: Aetna Medicare Advantage	$861.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.36
Rate for Payer: Cigna Commercial	$1,436.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.02
Rate for Payer: Qualcare PPO/HMO/WC	$430.80

TIBIAL ANT ALLOGR 10X20 062046

Facility

$5,528.25

Hospital Charge Code	270638702
Hospital Revenue Code	278
Min. Negotiated Rate	$829.24
Max. Negotiated Rate	$1,337.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.84
Rate for Payer: Qualcare PPO/HMO/WC	$829.24

TIBIAL ANT ALLOGR 10X20 062046

Facility

$5,528.25

Hospital Charge Code	270638702
Hospital Revenue Code	278
Min. Negotiated Rate	$829.24
Max. Negotiated Rate	$2,764.12
Rate for Payer: Aetna Commercial	$1,658.47
Rate for Payer: Aetna Medicare Advantage	$1,658.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,409.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,409.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,409.70
Rate for Payer: Cigna Commercial	$2,764.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.84
Rate for Payer: Qualcare PPO/HMO/WC	$829.24

TIBIAL ARTICULAR SUR SZ64 15MM

Facility

$13,273.75

Hospital Charge Code	270669473
Hospital Revenue Code	278
Min. Negotiated Rate	$1,991.06
Max. Negotiated Rate	$3,212.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,654.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,212.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.06

TIBIAL ARTICULAR SUR SZ64 15MM

Facility

$13,273.75

Hospital Charge Code	270669473
Hospital Revenue Code	278
Min. Negotiated Rate	$1,991.06
Max. Negotiated Rate	$6,636.88
Rate for Payer: Aetna Commercial	$3,982.12
Rate for Payer: Aetna Medicare Advantage	$3,982.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,384.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,384.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,654.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,384.81
Rate for Payer: Cigna Commercial	$6,636.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,212.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.06

TIBIAL ATTU ROTAT SZ 5 5MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690791
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

TIBIAL ATTU ROTAT SZ 5 5MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690791
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

TIBIAL AUG BLK SZ 2T 8MM

Facility

$3,864.00

Service Code	HCPCS C1776
Hospital Charge Code	270677687
Hospital Revenue Code	278
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$935.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.09
Rate for Payer: Qualcare PPO/HMO/WC	$579.60

TIBIAL AUG BLK SZ 2T 8MM

Facility

$3,864.00

Service Code	HCPCS C1776
Hospital Charge Code	270677687
Hospital Revenue Code	278
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$1,932.00
Rate for Payer: Aetna Commercial	$1,159.20
Rate for Payer: Aetna Medicare Advantage	$1,159.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$985.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$985.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$985.32
Rate for Payer: Cigna Commercial	$1,932.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.09
Rate for Payer: Qualcare PPO/HMO/WC	$579.60

TIBIAL AUG BLK SZ 3 11MM LLRM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671717
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TIBIAL AUG BLK SZ 3 11MM LLRM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671717
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TIBIAL AUG BLK SZ 3 11MM RLLM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671718
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TIBIAL AUG BLK SZ 3 11MM RLLM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671718
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TIBIAL AUG BLK SZ 3T 8MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673569
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TIBIAL AUG BLK SZ 3T 8MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673569
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,158.30
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

TIBIAL AUGMENATION # 2 20MM LM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687675
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,310.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

TIBIAL AUGMENATION # 2 20MM LM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687675
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

TIBIAL AUGMENATION # 2 20MM RM

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270687674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

Know your out-of-pocket cost for care.

All Charges