Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL INSRT POST STB SZ5 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677578
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSRT POST STB SZ5 9MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677825
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSRT POST STB SZ5 9MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677825
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSRT & SCREW SZ 1 22MM

Facility

$6,903.00

Hospital Charge Code	270670040
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSRT & SCREW SZ 1 22MM

Facility

$6,903.00

Hospital Charge Code	270670040
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSRT & SCRW SZ2 18MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270670552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSRT & SCRW SZ2 18MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270670552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSRT SCW COND SZ4 18MM

Facility

$6,903.00

Hospital Charge Code	270670649
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,070.90
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSRT SCW COND SZ4 18MM

Facility

$6,903.00

Hospital Charge Code	270670649
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSRT TRIAL PS SZ5 11MM

Facility

$1,360.00

Hospital Charge Code	270672139
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$329.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.12
Rate for Payer: Qualcare PPO/HMO/WC	$204.00

TIBIAL INSRT TRIAL PS SZ5 11MM

Facility

$1,360.00

Hospital Charge Code	270672139
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$680.00
Rate for Payer: Aetna Commercial	$408.00
Rate for Payer: Aetna Medicare Advantage	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$346.80
Rate for Payer: Cigna Commercial	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.12
Rate for Payer: Qualcare PPO/HMO/WC	$204.00

TIBIAL INSRT UC FIXED SZ4 14MM

Facility

$4,500.00

Hospital Charge Code	270675744
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 INSRT UC FIXED SZ4 14MM

Facility

$4,500.00

Hospital Charge Code	270675744
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 INST POST STAB SZ4 13MM

Facility

$5,996.25

Hospital Charge Code	270670037
Hospital Revenue Code	278
Min. Negotiated Rate	$899.44
Max. Negotiated Rate	$2,998.12
Rate for Payer: Aetna Commercial	$1,798.88
Rate for Payer: Aetna Medicare Advantage	$1,798.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,529.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,529.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,529.04
Rate for Payer: Cigna Commercial	$2,998.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.09
Rate for Payer: Qualcare PPO/HMO/WC	$899.44

TIBIAL INST POST STAB SZ4 13MM

Facility

$5,996.25

Hospital Charge Code	270670037
Hospital Revenue Code	278
Min. Negotiated Rate	$899.44
Max. Negotiated Rate	$1,451.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.09
Rate for Payer: Qualcare PPO/HMO/WC	$899.44

TIBIAL INS TRIATHLN X3 BEARING

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691272
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TIBIAL INS TRIATHLN X3 BEARING

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691272
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,495.58
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TIBIALIS TENDON POSTERIOR FF

Facility

$13,651.65

Service Code	HCPCS C1763
Hospital Charge Code	270698011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,047.75
Max. Negotiated Rate	$3,303.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,730.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,303.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,047.75

TIBIALIS TENDON POSTERIOR FF

Facility

$13,651.65

Service Code	HCPCS C1763
Hospital Charge Code	270698011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,047.75
Max. Negotiated Rate	$6,825.82
Rate for Payer: Aetna Commercial	$4,095.49
Rate for Payer: Aetna Medicare Advantage	$4,095.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,481.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,481.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,730.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,481.17
Rate for Payer: Cigna Commercial	$6,825.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,303.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,047.75

TIBIAL KEEL CMT SZ E LARGE PSN

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690150
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 KEEL CMT SZ E LARGE PSN

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690150
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 KEELED BASE CMT SZ3 RIG

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678166
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TIBIAL KEELED BASE CMT SZ3 RIG

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678166
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TIBIAL KNEE BASE FX BEAR SZ 2

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685557
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 KNEE BASE FX BEAR SZ 2

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685557
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

Know your out-of-pocket cost for care.

All Charges