Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

PATELLA BUTTON 31mm 184764

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639770
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 BUTTON 31mm 184764

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639770
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 CEMENTED 3 PEG 35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270668547
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 CEMENTED 3 PEG 35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270668547
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 CEMENTED 3 PEG 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668744
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 CEMENTED 3 PEG 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668744
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 COMPONENT

Facility

$6,705.00

Hospital Charge Code	270666806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.75
Max. Negotiated Rate	$1,622.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.75

PATELLA COMPONENT

Facility

$6,705.00

Hospital Charge Code	270666806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.75
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna Commercial	$2,011.50
Rate for Payer: Aetna Medicare Advantage	$2,011.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.78
Rate for Payer: Cigna Commercial	$3,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.75

PATELLA DOMED TRI SZ 35 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270691777
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$945.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PATELLA DOMED TRI SZ 35 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270691777
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678376
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678376
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678266
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678266
Hospital Revenue Code	272
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$107.25
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.48
Rate for Payer: Oxford Commercial	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$178.75

PATELLA INSTRUMENT SET

Facility

$500.00

Hospital Charge Code	270687769
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PATELLA INSTRUMENT SET

Facility

$500.00

Hospital Charge Code	270687769
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

PATELLA LAT VAL 2.4 /2.7 SS

Facility

$10,836.80

Service Code	HCPCS C1713
Hospital Charge Code	270694000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.52
Max. Negotiated Rate	$2,622.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.52

PATELLA LAT VAL 2.4 /2.7 SS

Facility

$10,836.80

Service Code	HCPCS C1713
Hospital Charge Code	270694000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.52
Max. Negotiated Rate	$5,418.40
Rate for Payer: Aetna Commercial	$3,251.04
Rate for Payer: Aetna Medicare Advantage	$3,251.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,763.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,763.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,763.38
Rate for Payer: Cigna Commercial	$5,418.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.52

PATELLA LIGAMENT 10MM PRECUT

Facility

$17,777.50

Hospital Charge Code	270670447
Hospital Revenue Code	278
Min. Negotiated Rate	$2,666.62
Max. Negotiated Rate	$8,888.75
Rate for Payer: Aetna Commercial	$5,333.25
Rate for Payer: Aetna Medicare Advantage	$5,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,533.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,533.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,533.26
Rate for Payer: Cigna Commercial	$8,888.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.62

PATELLA LIGAMENT 10MM PRECUT

Facility

$17,777.50

Hospital Charge Code	270670447
Hospital Revenue Code	278
Min. Negotiated Rate	$2,666.62
Max. Negotiated Rate	$4,302.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.62

PATELLA MEDIALIZED DOME 29 MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685561
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA MEDIALIZED DOME 29 MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685561
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA MEDIALIZED DOME 32MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685507
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA MEDIALIZED DOME 32MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685507
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Know your out-of-pocket cost for care.

All Charges