Heights University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA VANGRD STD 28MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692926
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 VANGRD STD 28MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692926
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 X3

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270677998
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$1,682.85
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

PATELLA X3

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270677998
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

PATELLA X3 TRIATHLON 11X40

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691995
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 X3 TRIATHLON 11X40

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691995
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 X3 TRIATHLON A20 11MM

Facility

$9,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270691992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,445.25
Max. Negotiated Rate	$4,817.50
Rate for Payer: Aetna Commercial	$2,890.50
Rate for Payer: Aetna Medicare Advantage	$2,890.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,456.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,456.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,927.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,456.93
Rate for Payer: Cigna Commercial	$4,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,331.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,445.25

PATELLA X3 TRIATHLON A20 11MM

Facility

$9,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270691992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,445.25
Max. Negotiated Rate	$2,331.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,927.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,331.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,445.25

PATELLA ZIM POLY 29MM 59726529

Facility

$3,242.90

Hospital Charge Code	270607658
Hospital Revenue Code	278
Min. Negotiated Rate	$486.44
Max. Negotiated Rate	$784.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.78
Rate for Payer: Qualcare PPO/HMO/WC	$486.44

PATELLA ZIM POLY 29MM 59726529

Facility

$3,242.90

Hospital Charge Code	270607658
Hospital Revenue Code	278
Min. Negotiated Rate	$486.44
Max. Negotiated Rate	$1,621.45
Rate for Payer: Aetna Commercial	$972.87
Rate for Payer: Aetna Medicare Advantage	$972.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.94
Rate for Payer: Cigna Commercial	$1,621.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.78
Rate for Payer: Qualcare PPO/HMO/WC	$486.44

PATELLA ZIM POLY 32MM 59726532

Facility

$2,998.20

Hospital Charge Code	270607475
Hospital Revenue Code	278
Min. Negotiated Rate	$449.73
Max. Negotiated Rate	$1,499.10
Rate for Payer: Aetna Commercial	$899.46
Rate for Payer: Aetna Medicare Advantage	$899.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$599.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.54
Rate for Payer: Cigna Commercial	$1,499.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$725.56
Rate for Payer: Qualcare PPO/HMO/WC	$449.73

PATELLA ZIM POLY 32MM 59726532

Facility

$2,998.20

Hospital Charge Code	270607475
Hospital Revenue Code	278
Min. Negotiated Rate	$449.73
Max. Negotiated Rate	$725.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$599.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$725.56
Rate for Payer: Qualcare PPO/HMO/WC	$449.73

PATELLA ZIM POLY 35MM 59726535

Facility

$3,242.45

Service Code	HCPCS C1776
Hospital Charge Code	270606757
Hospital Revenue Code	278
Min. Negotiated Rate	$486.37
Max. Negotiated Rate	$1,621.22
Rate for Payer: Aetna Commercial	$972.74
Rate for Payer: Aetna Medicare Advantage	$972.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.82
Rate for Payer: Cigna Commercial	$1,621.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.67
Rate for Payer: Qualcare PPO/HMO/WC	$486.37

PATELLA ZIM POLY 35MM 59726535

Facility

$3,242.45

Service Code	HCPCS C1776
Hospital Charge Code	270606757
Hospital Revenue Code	278
Min. Negotiated Rate	$486.37
Max. Negotiated Rate	$784.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.67
Rate for Payer: Qualcare PPO/HMO/WC	$486.37

PATELLA ZIM POLY 38MM 59726538

Facility

$3,432.85

Hospital Charge Code	270606474
Hospital Revenue Code	278
Min. Negotiated Rate	$514.93
Max. Negotiated Rate	$1,716.42
Rate for Payer: Aetna Commercial	$1,029.86
Rate for Payer: Aetna Medicare Advantage	$1,029.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$875.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$875.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$875.38
Rate for Payer: Cigna Commercial	$1,716.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.75
Rate for Payer: Qualcare PPO/HMO/WC	$514.93

PATELLA ZIM POLY 38MM 59726538

Facility

$3,432.85

Hospital Charge Code	270606474
Hospital Revenue Code	278
Min. Negotiated Rate	$514.93
Max. Negotiated Rate	$830.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.75
Rate for Payer: Qualcare PPO/HMO/WC	$514.93

PATELLOFEMORAL COMPON SZ4 LEFT

Facility

$12,580.00

Service Code	HCPCS C1776
Hospital Charge Code	270668855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL COMPON SZ4 LEFT

Facility

$12,580.00

Service Code	HCPCS C1776
Hospital Charge Code	270668855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$3,774.00
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 2

Facility

$12,580.00

Hospital Charge Code	270668853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$3,774.00
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 2

Facility

$12,580.00

Hospital Charge Code	270668853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 3

Facility

$12,580.00

Hospital Charge Code	270668854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$3,774.00
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 3

Facility

$12,580.00

Hospital Charge Code	270668854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 5

Facility

$12,580.00

Hospital Charge Code	270668856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 5

Facility

$12,580.00

Hospital Charge Code	270668856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$3,774.00
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 6

Facility

$12,580.00

Hospital Charge Code	270668857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

Know your out-of-pocket cost for care.

All Charges