Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL BASEPLATE 67MM

Facility

$19,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270681760
Hospital Revenue Code	278
Min. Negotiated Rate	$2,947.50
Max. Negotiated Rate	$9,825.00
Rate for Payer: Aetna Commercial	$5,895.00
Rate for Payer: Aetna Medicare Advantage	$5,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,010.75
Rate for Payer: Cigna Commercial	$9,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,755.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,947.50

TIBIAL BASEPLATE 67MM

Facility

$19,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270681760
Hospital Revenue Code	278
Min. Negotiated Rate	$2,947.50
Max. Negotiated Rate	$4,755.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,755.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,947.50

TIBIAL BASEPLATE CMA #5

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676677
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

TIBIAL BASEPLATE CMA #5

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676677
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

TIBIAL BASEPLATE STEMMED SZ 1

Facility

$7,500.00

Hospital Charge Code	270669294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

TIBIAL BASEPLATE STEMMED SZ 1

Facility

$7,500.00

Hospital Charge Code	270669294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

TIBIAL BASEPLATE SZ 1 ELEOS

Facility

$20,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270682847
Hospital Revenue Code	278
Min. Negotiated Rate	$3,035.25
Max. Negotiated Rate	$10,117.50
Rate for Payer: Aetna Commercial	$6,070.50
Rate for Payer: Aetna Medicare Advantage	$6,070.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,159.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,159.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,159.93
Rate for Payer: Cigna Commercial	$10,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,896.87
Rate for Payer: Qualcare PPO/HMO/WC	$3,035.25

TIBIAL BASEPLATE SZ 1 ELEOS

Facility

$20,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270682847
Hospital Revenue Code	278
Min. Negotiated Rate	$3,035.25
Max. Negotiated Rate	$4,896.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,047.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,896.87
Rate for Payer: Qualcare PPO/HMO/WC	$3,035.25

TIBIAL BASEPLATE SZ 2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678878
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

TIBIAL BASEPLATE SZ 2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678878
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

TIBIAL BASEPLATE SZ 3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678829
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

TIBIAL BASEPLATE SZ 3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678829
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

TIBIAL BASEPLATE SZ 4

Facility

$8,488.25

Hospital Charge Code	270671355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.24
Max. Negotiated Rate	$2,054.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,697.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,054.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,273.24

TIBIAL BASEPLATE SZ 4

Facility

$8,488.25

Hospital Charge Code	270671355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.24
Max. Negotiated Rate	$4,244.12
Rate for Payer: Aetna Commercial	$2,546.47
Rate for Payer: Aetna Medicare Advantage	$2,546.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,164.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,164.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,697.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,164.50
Rate for Payer: Cigna Commercial	$4,244.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,054.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,273.24

TIBIAL BASEPLATE SZ4 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680134
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

TIBIAL BASEPLATE SZ4 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680134
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

TIBIAL BASEPLATE SZ5 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680135
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

TIBIAL BASEPLATE SZ5 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680135
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

TIBIAL BEARING

Facility

$12,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270672775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,847.25
Max. Negotiated Rate	$2,980.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.25

TIBIAL BEARING

Facility

$12,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270672775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,847.25
Max. Negotiated Rate	$6,157.50
Rate for Payer: Aetna Commercial	$3,694.50
Rate for Payer: Aetna Medicare Advantage	$3,694.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,140.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,140.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,140.32
Rate for Payer: Cigna Commercial	$6,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.25

TIBIAL BEARING 12MM X 63/67MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681314
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

TIBIAL BEARING 12MM X 63/67MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681314
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 BEARING 18MM

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673718
Hospital Revenue Code	278
Min. Negotiated Rate	$912.75
Max. Negotiated Rate	$3,042.50
Rate for Payer: Aetna Commercial	$1,825.50
Rate for Payer: Aetna Medicare Advantage	$1,825.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,551.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,551.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,551.67
Rate for Payer: Cigna Commercial	$3,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,472.57
Rate for Payer: Qualcare PPO/HMO/WC	$912.75

TIBIAL BEARING 18MM

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673718
Hospital Revenue Code	278
Min. Negotiated Rate	$912.75
Max. Negotiated Rate	$1,472.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,472.57
Rate for Payer: Qualcare PPO/HMO/WC	$912.75

TIBIAL BEARING INS CS4 9.0MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692202
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,524.70
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

Know your out-of-pocket cost for care.

All Charges