Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270676450
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

TIBIAL CUTTING BLOCK SZ2 RIGHT

Facility

$2,625.00

Hospital Charge Code	270672252
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 SZ2 RIGHT

Facility

$2,625.00

Hospital Charge Code	270672252
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 SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671996
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

TIBIAL CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671996
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

TIBIAL CUTTING BLOCK UNIVERAL

Facility

$4,200.00

Hospital Charge Code	270686931
Hospital Revenue Code	272
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$630.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

TIBIAL CUTTING BLOCK UNIVERAL

Facility

$4,200.00

Hospital Charge Code	270686931
Hospital Revenue Code	272
Min. Negotiated Rate	$546.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,260.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.00
Rate for Payer: Oxford Commercial	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Commercial	$2,100.00

TIBIAL ELEOS MODUL CAP ONE SZ

Facility

$850.00

Service Code	HCPCS C1776
Hospital Charge Code	270682848
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

TIBIAL ELEOS MODUL CAP ONE SZ

Facility

$850.00

Service Code	HCPCS C1776
Hospital Charge Code	270682848
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

TIBIAL FIXED KEEL CMT SZ D L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

TIBIAL FIXED KEEL CMT SZ D L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$5,546.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

TIBIAL GMK TRAY HINGE 20 MM S

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$4,471.50
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE 20 MM S

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE 2 20MM

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687695
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$4,471.50
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE 2 20MM

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687695
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE RIGHT S4

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687949
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$5,891.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

TIBIAL GMK TRAY HINGE RIGHT S4

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687949
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$12,172.50
Rate for Payer: Aetna Commercial	$7,303.50
Rate for Payer: Aetna Medicare Advantage	$7,303.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,207.98
Rate for Payer: Cigna Commercial	$12,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

TIBIAL HINGE ELEOS ROTIONAL ST

Facility

$11,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270682843
Hospital Revenue Code	278
Min. Negotiated Rate	$1,746.75
Max. Negotiated Rate	$2,818.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,818.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.75

TIBIAL HINGE ELEOS ROTIONAL ST

Facility

$11,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270682843
Hospital Revenue Code	278
Min. Negotiated Rate	$1,746.75
Max. Negotiated Rate	$5,822.50
Rate for Payer: Aetna Commercial	$3,493.50
Rate for Payer: Aetna Medicare Advantage	$3,493.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,969.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,969.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,329.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,969.47
Rate for Payer: Cigna Commercial	$5,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,818.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.75

TIBIAL INLAY POLY SZ 1 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668679
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668679
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,186.50
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668680
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,186.50
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668680
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668681
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,186.50
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668681
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

Know your out-of-pocket cost for care.

All Charges