Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL INLAY POLY SZ 6 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668694
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 6 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668695
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 6 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668695
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 6 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668696
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 6 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668696
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 7 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668697
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 7 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668697
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 7 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668698
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 7 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668698
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 7 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668699
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 7 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668699
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 8 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668700
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 8 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668700
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 8 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668701
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 8 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668701
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 8 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668702
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 8 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668702
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 INSERT

Facility

$6,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270667711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT

Facility

$6,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270667711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$3,472.50
Rate for Payer: Aetna Commercial	$2,083.50
Rate for Payer: Aetna Medicare Advantage	$2,083.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.97
Rate for Payer: Cigna Commercial	$3,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT 11MM SZ 5 LEFT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683576
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TIBIAL INSERT 11MM SZ 5 LEFT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683576
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TIBIAL INSERT 17MM

Facility

$6,945.00

Hospital Charge Code	270672087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT 17MM

Facility

$6,945.00

Hospital Charge Code	270672087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$3,472.50
Rate for Payer: Aetna Commercial	$2,083.50
Rate for Payer: Aetna Medicare Advantage	$2,083.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.97
Rate for Payer: Cigna Commercial	$3,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT 5/13MMRIGHT FLEX

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681016
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TIBIAL INSERT 5/13MMRIGHT FLEX

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681016
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges