Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TIBIAL BEARING INSERT 11MM

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270681037
Hospital Revenue Code	278
Min. Negotiated Rate	$777.32
Max. Negotiated Rate	$2,591.05
Rate for Payer: Aetna Commercial	$1,554.63
Rate for Payer: Aetna Medicare Advantage	$1,554.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.44
Rate for Payer: Cigna Commercial	$2,591.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.32

TIBIAL BEARING INSERT 11MM

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270681037
Hospital Revenue Code	278
Min. Negotiated Rate	$777.32
Max. Negotiated Rate	$1,254.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.32

TIBIAL BEARING INSERT 13MM

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270691037
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

TIBIAL BEARING INSERT 13MM

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270691037
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

TIBIAL BEARING INSERT SZ 1

Facility

$5,233.60

Service Code	HCPCS C1713
Hospital Charge Code	270705094
Hospital Revenue Code	278
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$1,266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,266.53
Rate for Payer: Qualcare PPO/HMO/WC	$785.04

TIBIAL BEARING INSERT SZ 1

Facility

$5,233.60

Service Code	HCPCS C1713
Hospital Charge Code	270705094
Hospital Revenue Code	278
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$2,616.80
Rate for Payer: Aetna Commercial	$1,570.08
Rate for Payer: Aetna Medicare Advantage	$1,570.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,334.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,334.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,334.57
Rate for Payer: Cigna Commercial	$2,616.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,266.53
Rate for Payer: Qualcare PPO/HMO/WC	$785.04

TIBIAL BEARING INSERT SZ 2

Facility

$5,208.30

Service Code	HCPCS C1713
Hospital Charge Code	270705127
Hospital Revenue Code	278
Min. Negotiated Rate	$781.25
Max. Negotiated Rate	$2,604.15
Rate for Payer: Aetna Commercial	$1,562.49
Rate for Payer: Aetna Medicare Advantage	$1,562.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.12
Rate for Payer: Cigna Commercial	$2,604.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.25

TIBIAL BEARING INSERT SZ 2

Facility

$5,208.30

Service Code	HCPCS C1713
Hospital Charge Code	270705127
Hospital Revenue Code	278
Min. Negotiated Rate	$781.25
Max. Negotiated Rate	$1,260.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.25

TIBIAL BEARING INSERT SZ4 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697649
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TIBIAL BEARING INSERT SZ4 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697649
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,495.59
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TIBIAL BEARING INSRT PS 5/11MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BEARING INSRT PS 5/11MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,062.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BEARING INSRT PS 5/16MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,062.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BEARING INSRT PS 5/16MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BONE MODEL

Facility

$500.00

Hospital Charge Code	270672254
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BONE MODEL

Facility

$500.00

Hospital Charge Code	270672254
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

TIBIAL BONE MODEL 4.9020

Facility

$500.00

Hospital Charge Code	270672255
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BONE MODEL 4.9020

Facility

$500.00

Hospital Charge Code	270672255
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BUSHING

Facility

$1,605.00

Service Code	HCPCS C1713
Hospital Charge Code	270664277
Hospital Revenue Code	278
Min. Negotiated Rate	$240.75
Max. Negotiated Rate	$388.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.41
Rate for Payer: Qualcare PPO/HMO/WC	$240.75

TIBIAL BUSHING

Facility

$1,605.00

Service Code	HCPCS C1713
Hospital Charge Code	270664277
Hospital Revenue Code	278
Min. Negotiated Rate	$240.75
Max. Negotiated Rate	$802.50
Rate for Payer: Aetna Commercial	$481.50
Rate for Payer: Aetna Medicare Advantage	$481.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.27
Rate for Payer: Cigna Commercial	$802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.41
Rate for Payer: Qualcare PPO/HMO/WC	$240.75

TIBIAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668097
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$135.00

TIBIAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668097
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

TIBIAL COMPENT 32x6.5 102140

Facility

$3,774.65

Hospital Charge Code	270631693
Hospital Revenue Code	278
Min. Negotiated Rate	$566.20
Max. Negotiated Rate	$1,887.33
Rate for Payer: Aetna Commercial	$1,132.39
Rate for Payer: Aetna Medicare Advantage	$1,132.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$962.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$962.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$962.54
Rate for Payer: Cigna Commercial	$1,887.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$913.47
Rate for Payer: Qualcare PPO/HMO/WC	$566.20

TIBIAL COMPENT 32x6.5 102140

Facility

$3,774.65

Hospital Charge Code	270631693
Hospital Revenue Code	278
Min. Negotiated Rate	$566.20
Max. Negotiated Rate	$913.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$913.47
Rate for Payer: Qualcare PPO/HMO/WC	$566.20

Know your out-of-pocket cost for care.

All Charges