Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 AUGMEN SCREWED S410MM

Facility

$7,065.00

Service Code	HCPCS C1776
Hospital Charge Code	270687964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.75
Max. Negotiated Rate	$3,532.50
Rate for Payer: Aetna Commercial	$2,119.50
Rate for Payer: Aetna Medicare Advantage	$2,119.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,801.58
Rate for Payer: Cigna Commercial	$3,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,709.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.75

TIBIAL AUGMEN SCREWED S410MM

Facility

$7,065.00

Service Code	HCPCS C1776
Hospital Charge Code	270687964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.75
Max. Negotiated Rate	$1,709.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,413.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,709.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.75

TIBIAL AUGMENT BK 1/2 SZ1 18MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673369
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 AUGMENT BK 1/2 SZ1 18MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270673369
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 AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687123
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$2,582.50
Rate for Payer: Aetna Commercial	$1,549.50
Rate for Payer: Aetna Medicare Advantage	$1,549.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.08
Rate for Payer: Cigna Commercial	$2,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687123
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$1,249.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687122
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$1,249.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

TIBIAL AUGMENT BLOCK

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270687122
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$2,582.50
Rate for Payer: Aetna Commercial	$1,549.50
Rate for Payer: Aetna Medicare Advantage	$1,549.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.08
Rate for Payer: Cigna Commercial	$2,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

TIBIAL AUG. SCREWS SZ4T RT LAT

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680583
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 AUG. SCREWS SZ4T RT LAT

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680583
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. SCREWS SZ4T RT MED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680584
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 AUG. SCREWS SZ4T RT MED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680584
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 SCREW SZ 2T 11MM LA

Facility

$413.75

Service Code	HCPCS C1713
Hospital Charge Code	270683131
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$206.88
Rate for Payer: Aetna Commercial	$124.12
Rate for Payer: Aetna Medicare Advantage	$124.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.51
Rate for Payer: Cigna Commercial	$206.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

TIBIAL AUG SCREW SZ 2T 11MM LA

Facility

$413.75

Service Code	HCPCS C1713
Hospital Charge Code	270683131
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$100.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

TIBIAL AUG SCREW SZ 2T 11MM ME

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270683132
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 AUG SCREW SZ 2T 11MM ME

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270683132
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 BASE

Facility

$9,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

TIBIAL BASE

Facility

$9,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$2,700.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

TIBIAL BASE ADVAN COCR NP SZ4

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697441
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

TIBIAL BASE ADVAN COCR NP SZ4

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697441
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$4,200.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

TIBIAL BASE COMPONENT SZ 2

Facility

$29,665.00

Hospital Charge Code	270669431
Hospital Revenue Code	278
Min. Negotiated Rate	$4,449.75
Max. Negotiated Rate	$7,178.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,933.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,178.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,449.75

TIBIAL BASE COMPONENT SZ 2

Facility

$29,665.00

Hospital Charge Code	270669431
Hospital Revenue Code	278
Min. Negotiated Rate	$4,449.75
Max. Negotiated Rate	$14,832.50
Rate for Payer: Aetna Commercial	$8,899.50
Rate for Payer: Aetna Medicare Advantage	$8,899.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,564.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,564.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,933.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,564.57
Rate for Payer: Cigna Commercial	$14,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,178.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,449.75

TIBIAL BASEPLATE #5

Facility

$4,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270692142
Hospital Revenue Code	278
Min. Negotiated Rate	$670.50
Max. Negotiated Rate	$2,235.00
Rate for Payer: Aetna Commercial	$1,341.00
Rate for Payer: Aetna Medicare Advantage	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,139.85
Rate for Payer: Cigna Commercial	$2,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: Qualcare PPO/HMO/WC	$670.50

TIBIAL BASEPLATE #5

Facility

$4,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270692142
Hospital Revenue Code	278
Min. Negotiated Rate	$670.50
Max. Negotiated Rate	$1,081.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: Qualcare PPO/HMO/WC	$670.50

Know your out-of-pocket cost for care.

All Charges