Heights University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA NEXGEN POROUS TM 10X

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270698908
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.00
Max. Negotiated Rate	$2,265.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,265.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.00

PATELLA NEXGEN POROUS TM 10X

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270698908
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.00
Max. Negotiated Rate	$4,680.00
Rate for Payer: Aetna Commercial	$2,808.00
Rate for Payer: Aetna Medicare Advantage	$2,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,386.80
Rate for Payer: Cigna Commercial	$4,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,265.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.00

PATELLA NEX MICRO 26m 59726126

Facility

$3,118.15

Hospital Charge Code	270630185
Hospital Revenue Code	278
Min. Negotiated Rate	$467.72
Max. Negotiated Rate	$754.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$623.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$754.59
Rate for Payer: Qualcare PPO/HMO/WC	$467.72

PATELLA NEX MICRO 26m 59726126

Facility

$3,118.15

Hospital Charge Code	270630185
Hospital Revenue Code	278
Min. Negotiated Rate	$467.72
Max. Negotiated Rate	$1,559.08
Rate for Payer: Aetna Commercial	$935.45
Rate for Payer: Aetna Medicare Advantage	$935.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$795.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$795.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$623.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$795.13
Rate for Payer: Cigna Commercial	$1,559.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$754.59
Rate for Payer: Qualcare PPO/HMO/WC	$467.72

PATELLA ON SET 3 PEGS 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676679
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 ON SET 3 PEGS 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676679
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 PEG 3 CEMENT 41MM DIA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670648
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 PEG 3 CEMENT 41MM DIA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670648
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 PLUSDOMED TRI PEG 32

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692522
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 PLUSDOMED TRI PEG 32

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692522
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, POLY 29MM NEXGEN A

Facility

$2,300.00

Hospital Charge Code	270665752
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

PATELLA, POLY 29MM NEXGEN A

Facility

$2,300.00

Hospital Charge Code	270665752
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$690.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

PATELLA POROUS 10X38 587806538

Facility

$6,750.00

Hospital Charge Code	270637705
Hospital Revenue Code	272
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.50
Rate for Payer: Oxford Commercial	$3,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Commercial	$3,375.00

PATELLA POROUS 10X38 587806538

Facility

$6,750.00

Hospital Charge Code	270637705
Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PATELLA PRIMARY 34mm SERIES A

Facility

$4,865.00

Hospital Charge Code	270646500
Hospital Revenue Code	278
Min. Negotiated Rate	$729.75
Max. Negotiated Rate	$2,432.50
Rate for Payer: Aetna Commercial	$1,459.50
Rate for Payer: Aetna Medicare Advantage	$1,459.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.58
Rate for Payer: Cigna Commercial	$2,432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.33
Rate for Payer: Qualcare PPO/HMO/WC	$729.75

PATELLA PRIMARY 34mm SERIES A

Facility

$4,865.00

Hospital Charge Code	270646500
Hospital Revenue Code	278
Min. Negotiated Rate	$729.75
Max. Negotiated Rate	$1,177.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.33
Rate for Payer: Qualcare PPO/HMO/WC	$729.75

PATELLA PRIMARY REGENEREX 3PEG

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270655089
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

PATELLA PRIMARY REGENEREX 3PEG

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270655089
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

PATELLA PSN ALL POLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689503
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 PSN ALL POLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689503
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 PSN ALL POLY 32 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686544
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 PSN ALL POLY 32 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686544
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

PATELLAR BUTTON STD AGC

Facility

$1,870.00

Hospital Charge Code	270654366
Hospital Revenue Code	278
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.54
Rate for Payer: Qualcare PPO/HMO/WC	$280.50

PATELLAR BUTTON STD AGC

Facility

$1,870.00

Hospital Charge Code	270654366
Hospital Revenue Code	278
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$935.00
Rate for Payer: Aetna Commercial	$561.00
Rate for Payer: Aetna Medicare Advantage	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.85
Rate for Payer: Cigna Commercial	$935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.54
Rate for Payer: Qualcare PPO/HMO/WC	$280.50

PATELLAR COMPONENT OVAL SZ

Facility

$2,750.00

Hospital Charge Code	270667534
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

Know your out-of-pocket cost for care.

All Charges