Heights University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL TRAY TRAPEZOID SZ5F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672124
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 TRAY TRAPEZOID SZ5F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672124
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 TRAY TRAP SZ1F/1T 2F/1T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671565
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 TRAY TRAP SZ1F/1T 2F/1T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671565
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 TRAY TRAP SZ1F/2T,2F/2T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270668733
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$4,451.62
Rate for Payer: Aetna Commercial	$2,670.97
Rate for Payer: Aetna Medicare Advantage	$2,670.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.33
Rate for Payer: Cigna Commercial	$4,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TIBIAL TRAY TRAP SZ1F/2T,2F/2T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270668733
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$2,154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TIBIAL TRAY TRAP SZ1F/3T 2F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669784
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 TRAY TRAP SZ1F/3T 2F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669784
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 TRAY TRAP SZ 4F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673795
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 TRAY TRAP SZ 4F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673795
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 TRAY TRAP SZ 4F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675367
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 TRAY TRAP SZ 4F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675367
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 TRIATHLON BP SZ #7

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270681038
Hospital Revenue Code	278
Min. Negotiated Rate	$666.98
Max. Negotiated Rate	$2,223.28
Rate for Payer: Aetna Commercial	$1,333.96
Rate for Payer: Aetna Medicare Advantage	$1,333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,133.87
Rate for Payer: Cigna Commercial	$2,223.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: Qualcare PPO/HMO/WC	$666.98

TIBIAL TRIATHLON BP SZ #7

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270681038
Hospital Revenue Code	278
Min. Negotiated Rate	$666.98
Max. Negotiated Rate	$1,076.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: Qualcare PPO/HMO/WC	$666.98

TIBIAL TRY PRMRY 75mm W/LCK BR

Facility

$10,020.00

Hospital Charge Code	270647012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.00
Max. Negotiated Rate	$5,010.00
Rate for Payer: Aetna Commercial	$3,006.00
Rate for Payer: Aetna Medicare Advantage	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,555.10
Rate for Payer: Cigna Commercial	$5,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00

TIBIAL TRY PRMRY 75mm W/LCK BR

Facility

$10,020.00

Hospital Charge Code	270647012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.00
Max. Negotiated Rate	$2,424.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00

TIBIAL TRY SIZE F OXFRD 154776

Facility

$7,715.00

Hospital Charge Code	270639310
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.25
Max. Negotiated Rate	$3,857.50
Rate for Payer: Cigna Commercial	$3,857.50
Rate for Payer: Aetna Commercial	$2,314.50
Rate for Payer: Aetna Medicare Advantage	$2,314.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,967.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,967.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,967.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,867.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,157.25

TIBIAL TRY SIZE F OXFRD 154776

Facility

$7,715.00

Hospital Charge Code	270639310
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.25
Max. Negotiated Rate	$1,867.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,867.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,157.25

TIBIAL UNIVERSAL SZ7 RT

Facility

$10,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270692526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,535.25
Max. Negotiated Rate	$5,117.50
Rate for Payer: Aetna Commercial	$3,070.50
Rate for Payer: Aetna Medicare Advantage	$3,070.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,609.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,609.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,609.93
Rate for Payer: Cigna Commercial	$5,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,476.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,535.25

TIBIAL UNIVERSAL SZ7 RT

Facility

$10,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270692526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,535.25
Max. Negotiated Rate	$2,476.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,047.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,476.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,535.25

TIBIA MONOBLK SZ7 GH 588604710

Facility

$18,170.00

Hospital Charge Code	270637704
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.50
Max. Negotiated Rate	$4,397.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,634.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,397.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,725.50

TIBIA MONOBLK SZ7 GH 588604710

Facility

$18,170.00

Hospital Charge Code	270637704
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.50
Max. Negotiated Rate	$9,085.00
Rate for Payer: Aetna Commercial	$5,451.00
Rate for Payer: Aetna Medicare Advantage	$5,451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,633.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,633.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,634.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,633.35
Rate for Payer: Cigna Commercial	$9,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,397.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,725.50

TIBIA NP CEMENTED SZ2 RT STD

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

TIBIA NP CEMENTED SZ2 RT STD

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$4,200.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

TIBIA POR COASTED SZ 11 LEFT

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

Know your out-of-pocket cost for care.

All Charges