Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRAY TIBIAL FIXED SZ4RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680716
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

TRAY TIBIAL FIXED SZ5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677519
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

TRAY TIBIAL FIXED SZ5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677519
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

TRAY TIBIAL I-BEAM 63mm

Facility

$6,610.00

Hospital Charge Code	270671041
Hospital Revenue Code	278
Min. Negotiated Rate	$991.50
Max. Negotiated Rate	$1,599.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.62
Rate for Payer: Qualcare PPO/HMO/WC	$991.50

TRAY TIBIAL I-BEAM 63mm

Facility

$6,610.00

Hospital Charge Code	270671041
Hospital Revenue Code	278
Min. Negotiated Rate	$991.50
Max. Negotiated Rate	$3,305.00
Rate for Payer: Aetna Commercial	$1,983.00
Rate for Payer: Aetna Medicare Advantage	$1,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,685.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,685.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,685.55
Rate for Payer: Cigna Commercial	$3,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.62
Rate for Payer: Qualcare PPO/HMO/WC	$991.50

TRAY TIBIAL REGENEREX PRIMARY

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270663938
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$1,950.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

TRAY TIBIAL REGENEREX PRIMARY

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270663938
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

TRAY TIBIAL SZ3 58420302

Facility

$6,437.75

Hospital Charge Code	270635698
Hospital Revenue Code	278
Min. Negotiated Rate	$965.66
Max. Negotiated Rate	$3,218.88
Rate for Payer: Aetna Commercial	$1,931.33
Rate for Payer: Aetna Medicare Advantage	$1,931.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,641.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,641.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,641.63
Rate for Payer: Cigna Commercial	$3,218.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,557.94
Rate for Payer: Qualcare PPO/HMO/WC	$965.66

TRAY TIBIAL SZ3 58420302

Facility

$6,437.75

Hospital Charge Code	270635698
Hospital Revenue Code	278
Min. Negotiated Rate	$965.66
Max. Negotiated Rate	$1,557.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,287.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,557.94
Rate for Payer: Qualcare PPO/HMO/WC	$965.66

TRAY TIBIAL SZ E RT MED 154727

Facility

$7,650.00

Hospital Charge Code	270638796
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$3,825.00
Rate for Payer: Aetna Commercial	$2,295.00
Rate for Payer: Aetna Medicare Advantage	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,950.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,950.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,950.75
Rate for Payer: Cigna Commercial	$3,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,851.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.50

TRAY TIBIAL SZ E RT MED 154727

Facility

$7,650.00

Hospital Charge Code	270638796
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$1,851.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,851.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.50

TRAY TIBIAL TRAPEZOID SZ 3F/2T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677100
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

TRAY TIBIAL TRAPEZOID SZ 3F/2T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677100
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

TRAY TIBIAL TRAPEZOID SZ 3F/3T

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270668746
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Commercial	$2,493.00
Rate for Payer: Aetna Medicare Advantage	$2,493.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,119.05
Rate for Payer: Cigna Commercial	$4,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

TRAY TIBIAL TRAPEZOID SZ 3F/3T

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270668746
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$2,011.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

TRAY TIBIAL TRAPEZOID SZ 4FT/4

Facility

$8,903.25

Hospital Charge Code	270669600
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

TRAY TIBIAL TRAPEZOID SZ 4FT/4

Facility

$8,903.25

Hospital Charge Code	270669600
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

TRAY TIBIAL TRAPEZOID SZ 5F/4T

Facility

$5,000.00

Hospital Charge Code	270677252
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

TRAY TIBIAL TRAPEZOID SZ 5F/4T

Facility

$5,000.00

Hospital Charge Code	270677252
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

TRAY TIBIAL TRAPEZOID SZ 6F/6T

Facility

$11,560.00

Hospital Charge Code	270668934
Hospital Revenue Code	278
Min. Negotiated Rate	$1,734.00
Max. Negotiated Rate	$5,780.00
Rate for Payer: Aetna Commercial	$3,468.00
Rate for Payer: Aetna Medicare Advantage	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,947.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,947.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,947.80
Rate for Payer: Cigna Commercial	$5,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,797.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,734.00

TRAY TIBIAL TRAPEZOID SZ 6F/6T

Facility

$11,560.00

Hospital Charge Code	270668934
Hospital Revenue Code	278
Min. Negotiated Rate	$1,734.00
Max. Negotiated Rate	$2,797.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,797.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,734.00

TRAY TIB PLT STEM SZ1 59802701

Facility

$7,647.25

Hospital Charge Code	270633690
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.09
Max. Negotiated Rate	$1,850.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.09

TRAY TIB PLT STEM SZ1 59802701

Facility

$7,647.25

Hospital Charge Code	270633690
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.09
Max. Negotiated Rate	$3,823.62
Rate for Payer: Aetna Commercial	$2,294.18
Rate for Payer: Aetna Medicare Advantage	$2,294.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,950.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,950.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,950.05
Rate for Payer: Cigna Commercial	$3,823.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.09

TRAY TIB SZ C RIGHT MED 154723

Facility

$7,715.00

Hospital Charge Code	270639865
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

TRAY TIB SZ C RIGHT MED 154723

Facility

$7,715.00

Hospital Charge Code	270639865
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.25
Max. Negotiated Rate	$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: Cigna Commercial	$3,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,867.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,157.25

Know your out-of-pocket cost for care.

All Charges