Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$5,775.00
Rate for Payer: Aetna Commercial	$3,465.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

TIBIA PRESSFIT BP 8 LT POROUS

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$3,465.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

TIBIA PRESSFIT BP 8 LT POROUS

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692263
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

TIBIA PSN ASF CPS VE6-9CD 12MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690108
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

TIBIA PSN ASF CPS VE6-9CD 12MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690108
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

TIBIA TALAR DOME SZ2 INF 12MM

Facility

$63,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270698107
Hospital Revenue Code	278
Min. Negotiated Rate	$9,490.50
Max. Negotiated Rate	$31,635.00
Rate for Payer: Aetna Commercial	$18,981.00
Rate for Payer: Aetna Medicare Advantage	$18,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,133.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,133.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,654.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,133.85
Rate for Payer: Cigna Commercial	$31,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,311.34
Rate for Payer: Qualcare PPO/HMO/WC	$9,490.50

TIBIA TALAR DOME SZ2 INF 12MM

Facility

$63,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270698107
Hospital Revenue Code	278
Min. Negotiated Rate	$9,490.50
Max. Negotiated Rate	$15,311.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,311.34
Rate for Payer: Qualcare PPO/HMO/WC	$9,490.50

TIBIA TOTAL ANKLE SZ2

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677296
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ2

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677296
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ4

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678163
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ4

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678163
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ4 +0MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

TIBIA TOTAL ANKLE SZ4 +0MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

TIBIA TRIAL VA 3.5 MM SM 3H LT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686032
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$1,094.85
Rate for Payer: Aetna Commercial	$656.91
Rate for Payer: Aetna Medicare Advantage	$656.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.37
Rate for Payer: Cigna Commercial	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA TRIAL VA 3.5 MM SM 3H LT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686032
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$529.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA TRIAL VA 3.5 MM SM 3H RT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686031
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$1,094.85
Rate for Payer: Aetna Commercial	$656.91
Rate for Payer: Aetna Medicare Advantage	$656.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.37
Rate for Payer: Cigna Commercial	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA TRIAL VA 3.5 MM SM 3H RT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686031
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$529.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA UNIVERSAL SZ6 LT EMPOWR

Facility

$10,337.50

Service Code	HCPCS C1776
Hospital Charge Code	270692549
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$5,168.75
Rate for Payer: Aetna Commercial	$3,101.25
Rate for Payer: Aetna Medicare Advantage	$3,101.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,636.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,636.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,636.06
Rate for Payer: Cigna Commercial	$5,168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.62

TIBIA UNIVERSAL SZ6 LT EMPOWR

Facility

$10,337.50

Service Code	HCPCS C1776
Hospital Charge Code	270692549
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$2,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.62

TIBIA Z NAIL 10MM X 30CM

Facility

$9,415.00

Hospital Charge Code	270658849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,412.25
Max. Negotiated Rate	$4,707.50
Rate for Payer: Aetna Commercial	$2,824.50
Rate for Payer: Aetna Medicare Advantage	$2,824.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,400.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,400.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,883.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,400.82
Rate for Payer: Cigna Commercial	$4,707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,278.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,412.25

TIBIA Z NAIL 10MM X 30CM

Facility

$9,415.00

Hospital Charge Code	270658849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,412.25
Max. Negotiated Rate	$2,278.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,278.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,412.25

TIBILA BEARING 67MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681761
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 67MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681761
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 75 MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270687124
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 75 MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270687124
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

Know your out-of-pocket cost for care.

All Charges