Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL COMPONENT 12MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270672591
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$4,320.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

TIBIAL COMPONENT 12MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270672591
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

TIBIAL COMPONENT 37x65 102150

Facility

$3,774.65

Hospital Charge Code	270630491
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

TIBIAL COMPONENT 37x65 102150

Facility

$3,774.65

Hospital Charge Code	270630491
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 COMPONENT 37x7.5 102152

Facility

$3,278.45

Hospital Charge Code	270631518
Hospital Revenue Code	278
Min. Negotiated Rate	$491.77
Max. Negotiated Rate	$1,639.22
Rate for Payer: Aetna Commercial	$983.53
Rate for Payer: Aetna Medicare Advantage	$983.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.00
Rate for Payer: Cigna Commercial	$1,639.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: Qualcare PPO/HMO/WC	$491.77

TIBIAL COMPONENT 37x7.5 102152

Facility

$3,278.45

Hospital Charge Code	270631518
Hospital Revenue Code	278
Min. Negotiated Rate	$491.77
Max. Negotiated Rate	$793.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: Qualcare PPO/HMO/WC	$491.77

TIBIAL COMPONENT 37X7.5 102154

Facility

$3,278.45

Hospital Charge Code	270631773
Hospital Revenue Code	278
Min. Negotiated Rate	$491.77
Max. Negotiated Rate	$793.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: Qualcare PPO/HMO/WC	$491.77

TIBIAL COMPONENT 37X7.5 102154

Facility

$3,278.45

Hospital Charge Code	270631773
Hospital Revenue Code	278
Min. Negotiated Rate	$491.77
Max. Negotiated Rate	$1,639.22
Rate for Payer: Aetna Commercial	$983.53
Rate for Payer: Aetna Medicare Advantage	$983.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.00
Rate for Payer: Cigna Commercial	$1,639.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: Qualcare PPO/HMO/WC	$491.77

TIBIAL COMPONENT # 5

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270691024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$1,654.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TIBIAL COMPONENT # 5

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270691024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$3,418.85
Rate for Payer: Aetna Commercial	$2,051.31
Rate for Payer: Aetna Medicare Advantage	$2,051.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.61
Rate for Payer: Cigna Commercial	$3,418.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TIBIAL COMPONENT 80MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676066
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT 80MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676066
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686974
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686974
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT SIZE 3 12MM

Facility

$5,695.00

Hospital Charge Code	270673197
Hospital Revenue Code	278
Min. Negotiated Rate	$854.25
Max. Negotiated Rate	$2,847.50
Rate for Payer: Aetna Commercial	$1,708.50
Rate for Payer: Aetna Medicare Advantage	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.22
Rate for Payer: Cigna Commercial	$2,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.19
Rate for Payer: Qualcare PPO/HMO/WC	$854.25

TIBIAL COMPONENT SIZE 3 12MM

Facility

$5,695.00

Hospital Charge Code	270673197
Hospital Revenue Code	278
Min. Negotiated Rate	$854.25
Max. Negotiated Rate	$1,378.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.19
Rate for Payer: Qualcare PPO/HMO/WC	$854.25

TIBIAL COMPONENT SIZE #4

Facility

$7,179.60

Service Code	HCPCS C1776
Hospital Charge Code	270690853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,076.94
Max. Negotiated Rate	$3,589.80
Rate for Payer: Aetna Commercial	$2,153.88
Rate for Payer: Aetna Medicare Advantage	$2,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,830.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,830.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,435.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,830.80
Rate for Payer: Cigna Commercial	$3,589.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,076.94

TIBIAL COMPONENT SIZE #4

Facility

$7,179.60

Service Code	HCPCS C1776
Hospital Charge Code	270690853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,076.94
Max. Negotiated Rate	$1,737.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,435.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,076.94

TIBIAL COMPONENT SMALL

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

TIBIAL COMPONENT SMALL

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

TIBIAL CUTTING BLOCK RT SZ3

Facility

$1,625.00

Hospital Charge Code	270673641
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

TIBIAL CUTTING BLOCK RT SZ3

Facility

$1,625.00

Hospital Charge Code	270673641
Hospital Revenue Code	272
Min. Negotiated Rate	$211.25
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$487.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.25
Rate for Payer: Oxford Commercial	$812.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$812.50

TIBIAL CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675307
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

TIBIAL CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675307
Hospital Revenue Code	272
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$787.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.25
Rate for Payer: Oxford Commercial	$1,312.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$1,312.50

TIBIAL CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270676450
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

Know your out-of-pocket cost for care.

All Charges