Heights University Hospital

All Charges

Charge

Type

Setting

Price

TBG

Facility

$390.00

Service Code	HCPCS 84442
Hospital Charge Code	39900140
Hospital Revenue Code	301
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.15
Rate for Payer: Cigna Commercial	$14.78
Rate for Payer: Cigna Medicare Advantage	$7.39
Rate for Payer: Clover Medicare Advantage	$14.04
Rate for Payer: EmblemHealth Commercial	$44.34
Rate for Payer: Humana Medicare Advantage	$15.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.67
Rate for Payer: Wellcare Medicare Advantage	$14.78

TBII

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900097
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TBII

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900097
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.62
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.42
Rate for Payer: Cigna Commercial	$18.40
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.50
Rate for Payer: Wellcare Medicare Advantage	$18.40

TBI N6 TRIATH TS PL X3 N6 9MM

Facility

$5,821.00

Service Code	HCPCS C1776
Hospital Charge Code	270694173
Hospital Revenue Code	278
Min. Negotiated Rate	$873.15
Max. Negotiated Rate	$1,408.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,164.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,408.68
Rate for Payer: Qualcare PPO/HMO/WC	$873.15

TBI N6 TRIATH TS PL X3 N6 9MM

Facility

$5,821.00

Service Code	HCPCS C1776
Hospital Charge Code	270694173
Hospital Revenue Code	278
Min. Negotiated Rate	$873.15
Max. Negotiated Rate	$2,910.50
Rate for Payer: Aetna Commercial	$1,746.30
Rate for Payer: Aetna Medicare Advantage	$1,746.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,484.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,484.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,164.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,484.36
Rate for Payer: Cigna Commercial	$2,910.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,408.68
Rate for Payer: Qualcare PPO/HMO/WC	$873.15

TBI PS SZ3 10MM

Facility

$5,212.45

Service Code	HCPCS C1776
Hospital Charge Code	270699195
Hospital Revenue Code	278
Min. Negotiated Rate	$781.87
Max. Negotiated Rate	$2,606.22
Rate for Payer: Aetna Commercial	$1,563.73
Rate for Payer: Aetna Medicare Advantage	$1,563.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,329.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,329.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,329.17
Rate for Payer: Cigna Commercial	$2,606.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.87

TBI PS SZ3 10MM

Facility

$5,212.45

Service Code	HCPCS C1776
Hospital Charge Code	270699195
Hospital Revenue Code	278
Min. Negotiated Rate	$781.87
Max. Negotiated Rate	$1,261.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.87

TBI TRIATHLON CS SZ 5 10MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697224
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,495.59
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI TRIATHLON CS SZ 5 10MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697224
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI TRIATHLON CS SZ 8

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695714
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,524.70
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON CS SZ 8

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695714
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON SZ4 CS 14MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270698940
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON SZ4 CS 14MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270698940
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,524.70
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON X3 SZ 2 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695587
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,524.70
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON X3 SZ 2 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695587
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON X3 SZ 4 CS 12MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270697368
Hospital Revenue Code	278
Min. Negotiated Rate	$762.36
Max. Negotiated Rate	$1,229.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: Qualcare PPO/HMO/WC	$762.36

TBI TRIATHLON X3 SZ 4 CS 12MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270697368
Hospital Revenue Code	278
Min. Negotiated Rate	$762.36
Max. Negotiated Rate	$2,541.20
Rate for Payer: Aetna Commercial	$1,524.72
Rate for Payer: Aetna Medicare Advantage	$1,524.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.01
Rate for Payer: Cigna Commercial	$2,541.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: Qualcare PPO/HMO/WC	$762.36

TBI TRIATH PS X3 SZ2 11MM

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694194
Hospital Revenue Code	278
Min. Negotiated Rate	$732.00
Max. Negotiated Rate	$2,440.00
Rate for Payer: Aetna Commercial	$1,464.00
Rate for Payer: Aetna Medicare Advantage	$1,464.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.40
Rate for Payer: Cigna Commercial	$2,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,180.96
Rate for Payer: Qualcare PPO/HMO/WC	$732.00

TBI TRIATH PS X3 SZ2 11MM

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694194
Hospital Revenue Code	278
Min. Negotiated Rate	$732.00
Max. Negotiated Rate	$1,180.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,180.96
Rate for Payer: Qualcare PPO/HMO/WC	$732.00

TBI TRIATH TS SZ6 11MM

Facility

$4,447.75

Service Code	HCPCS C1776
Hospital Charge Code	270694178
Hospital Revenue Code	278
Min. Negotiated Rate	$667.16
Max. Negotiated Rate	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.36
Rate for Payer: Qualcare PPO/HMO/WC	$667.16

TBI TRIATH TS SZ6 11MM

Facility

$4,447.75

Service Code	HCPCS C1776
Hospital Charge Code	270694178
Hospital Revenue Code	278
Min. Negotiated Rate	$667.16
Max. Negotiated Rate	$2,223.88
Rate for Payer: Aetna Commercial	$1,334.33
Rate for Payer: Aetna Medicare Advantage	$1,334.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.18
Rate for Payer: Cigna Commercial	$2,223.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.36
Rate for Payer: Qualcare PPO/HMO/WC	$667.16

TBI X3 PS TRIATHLON SZ4 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270694175
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,495.59
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI X3 PS TRIATHLON SZ4 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270694175
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI X3 TRIATHLON CS SZ7 11MM

Facility

$5,082.55

Service Code	HCPCS C1776
Hospital Charge Code	270694174
Hospital Revenue Code	278
Min. Negotiated Rate	$762.38
Max. Negotiated Rate	$2,541.28
Rate for Payer: Aetna Commercial	$1,524.77
Rate for Payer: Aetna Medicare Advantage	$1,524.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.05
Rate for Payer: Cigna Commercial	$2,541.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.98
Rate for Payer: Qualcare PPO/HMO/WC	$762.38

TBI X3 TRIATHLON CS SZ7 11MM

Facility

$5,082.55

Service Code	HCPCS C1776
Hospital Charge Code	270694174
Hospital Revenue Code	278
Min. Negotiated Rate	$762.38
Max. Negotiated Rate	$1,229.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.98
Rate for Payer: Qualcare PPO/HMO/WC	$762.38

Know your out-of-pocket cost for care.

All Charges