Heights University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA 3PEG CEMENTED 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681295
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3PEG CEMENTED 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681295
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3PEG CEMENTED 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675760
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3PEG CEMENTED 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675760
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3 PEG STD 28x8.0MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639116
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3 PEG STD 28x8.0MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639116
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3POST 34mm 11-150842

Facility

$3,530.00

Hospital Charge Code	270636753
Hospital Revenue Code	278
Min. Negotiated Rate	$529.50
Max. Negotiated Rate	$1,765.00
Rate for Payer: Aetna Commercial	$1,059.00
Rate for Payer: Aetna Medicare Advantage	$1,059.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$900.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$900.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$706.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$900.15
Rate for Payer: Cigna Commercial	$1,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.26
Rate for Payer: Qualcare PPO/HMO/WC	$529.50

PATELLA 3POST 34mm 11-150842

Facility

$3,530.00

Hospital Charge Code	270636753
Hospital Revenue Code	278
Min. Negotiated Rate	$529.50
Max. Negotiated Rate	$854.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$706.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.26
Rate for Payer: Qualcare PPO/HMO/WC	$529.50

PATELLA 3POST 37mm 11150844

Facility

$3,070.00

Hospital Charge Code	270642379
Hospital Revenue Code	278
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$742.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.94
Rate for Payer: Qualcare PPO/HMO/WC	$460.50

PATELLA 3POST 37mm 11150844

Facility

$3,070.00

Hospital Charge Code	270642379
Hospital Revenue Code	278
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$1,535.00
Rate for Payer: Aetna Commercial	$921.00
Rate for Payer: Aetna Medicare Advantage	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$782.85
Rate for Payer: Cigna Commercial	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.94
Rate for Payer: Qualcare PPO/HMO/WC	$460.50

PATELLA 41MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676728
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 41MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676728
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 41MM 10.0MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690961
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA 41MM 10.0MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690961
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,539.00
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA 51MM

Facility

$876.65

Service Code	HCPCS C1713
Hospital Charge Code	270656913
Hospital Revenue Code	278
Min. Negotiated Rate	$131.50
Max. Negotiated Rate	$212.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.15
Rate for Payer: Qualcare PPO/HMO/WC	$131.50

PATELLA 51MM

Facility

$876.65

Service Code	HCPCS C1713
Hospital Charge Code	270656913
Hospital Revenue Code	278
Min. Negotiated Rate	$131.50
Max. Negotiated Rate	$438.32
Rate for Payer: Aetna Commercial	$263.00
Rate for Payer: Aetna Medicare Advantage	$263.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.55
Rate for Payer: Cigna Commercial	$438.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.15
Rate for Payer: Qualcare PPO/HMO/WC	$131.50

PATELLA ADVANCE TRI-PEG 8X32MM

Facility

$0.05

Service Code	HCPCS C1776
Hospital Charge Code	270697718
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

PATELLA ADVANCE TRI-PEG 8X32MM

Facility

$0.05

Service Code	HCPCS C1776
Hospital Charge Code	270697718
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

PATELLA ALL POLY VE 29MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270693757
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,539.00
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA ALL POLY VE 29MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270693757
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA ASYMMETRIC 10X32

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691265
Hospital Revenue Code	278
Min. Negotiated Rate	$371.01
Max. Negotiated Rate	$598.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: Qualcare PPO/HMO/WC	$371.01

PATELLA ASYMMETRIC 10X32

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691265
Hospital Revenue Code	278
Min. Negotiated Rate	$371.01
Max. Negotiated Rate	$1,236.70
Rate for Payer: Aetna Commercial	$742.02
Rate for Payer: Aetna Medicare Advantage	$742.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.72
Rate for Payer: Cigna Commercial	$1,236.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: Qualcare PPO/HMO/WC	$371.01

PATELLA ASYMMETRIC A35 MM

Facility

$2,570.60

Service Code	HCPCS C1776
Hospital Charge Code	270691403
Hospital Revenue Code	278
Min. Negotiated Rate	$385.59
Max. Negotiated Rate	$1,285.30
Rate for Payer: Aetna Commercial	$771.18
Rate for Payer: Aetna Medicare Advantage	$771.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.50
Rate for Payer: Cigna Commercial	$1,285.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.09
Rate for Payer: Qualcare PPO/HMO/WC	$385.59

PATELLA ASYMMETRIC A35 MM

Facility

$2,570.60

Service Code	HCPCS C1776
Hospital Charge Code	270691403
Hospital Revenue Code	278
Min. Negotiated Rate	$385.59
Max. Negotiated Rate	$622.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.09
Rate for Payer: Qualcare PPO/HMO/WC	$385.59

PATELLA BMT X-SMALL

Facility

$2,912.00

Hospital Charge Code	270606317
Hospital Revenue Code	272
Min. Negotiated Rate	$436.80
Max. Negotiated Rate	$436.80
Rate for Payer: Qualcare PPO/HMO/WC	$436.80

Know your out-of-pocket cost for care.

All Charges