Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIATH FEM DIST AUG RTSZ5 10MM

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270697477
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$22,626.50
Rate for Payer: Aetna Commercial	$13,575.90
Rate for Payer: Aetna Medicare Advantage	$13,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,539.51
Rate for Payer: Cigna Commercial	$22,626.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEM DIST AUG RTSZ5 10MM

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270697477
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$10,951.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEMORAL COMP TS LT SZ2

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270699316
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$10,951.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEMORAL COMP TS LT SZ2

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270699316
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$22,626.50
Rate for Payer: Aetna Commercial	$13,575.90
Rate for Payer: Aetna Medicare Advantage	$13,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,539.51
Rate for Payer: Cigna Commercial	$22,626.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEM POST AUGMNT SZ5 5MM

Facility

$8,177.00

Service Code	HCPCS C1776
Hospital Charge Code	270697479
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.55
Max. Negotiated Rate	$4,088.50
Rate for Payer: Aetna Commercial	$2,453.10
Rate for Payer: Aetna Medicare Advantage	$2,453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,085.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,085.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,085.14
Rate for Payer: Cigna Commercial	$4,088.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.55

TRIATH FEM POST AUGMNT SZ5 5MM

Facility

$8,177.00

Service Code	HCPCS C1776
Hospital Charge Code	270697479
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.55
Max. Negotiated Rate	$1,978.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.55

TRIATH FEM STEM CMNT 12X100MM

Facility

$8,274.50

Service Code	HCPCS C1776
Hospital Charge Code	270697480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.17
Max. Negotiated Rate	$2,002.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,654.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,002.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.17

TRIATH FEM STEM CMNT 12X100MM

Facility

$8,274.50

Service Code	HCPCS C1776
Hospital Charge Code	270697480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.17
Max. Negotiated Rate	$4,137.25
Rate for Payer: Aetna Commercial	$2,482.35
Rate for Payer: Aetna Medicare Advantage	$2,482.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,654.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,110.00
Rate for Payer: Cigna Commercial	$4,137.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,002.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.17

TRIATHL CRUC RET FEM RTSZ2-CAP

Facility

$7,765.80

Service Code	HCPCS C1776
Hospital Charge Code	270692889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.87
Max. Negotiated Rate	$1,879.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,553.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,879.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.87

TRIATHL CRUC RET FEM RTSZ2-CAP

Facility

$7,765.80

Service Code	HCPCS C1776
Hospital Charge Code	270692889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.87
Max. Negotiated Rate	$3,882.90
Rate for Payer: Aetna Commercial	$2,329.74
Rate for Payer: Aetna Medicare Advantage	$2,329.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,980.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,980.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,553.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,980.28
Rate for Payer: Cigna Commercial	$3,882.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,879.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.87

TRIATHLON BASEPLATE SIZE 7

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$3,418.85
Rate for Payer: Aetna Commercial	$2,051.31
Rate for Payer: Aetna Medicare Advantage	$2,051.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.61
Rate for Payer: Cigna Commercial	$3,418.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TRIATHLON BASEPLATE SIZE 7

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$1,654.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TRIATHLON CR FEM COMP LT SZ6

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$3,158.84
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CR FEM COMP LT SZ6

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CR FEM COMPONENT 3L

Facility

$10,529.05

Service Code	HCPCS C1776
Hospital Charge Code	270692079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.36
Max. Negotiated Rate	$2,548.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.36

TRIATHLON CR FEM COMPONENT 3L

Facility

$10,529.05

Service Code	HCPCS C1776
Hospital Charge Code	270692079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.36
Max. Negotiated Rate	$5,264.52
Rate for Payer: Aetna Commercial	$3,158.72
Rate for Payer: Aetna Medicare Advantage	$3,158.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,684.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,684.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,684.91
Rate for Payer: Cigna Commercial	$5,264.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.36

TRIATHLON CRF SZ 4 SDE LFT T

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270692360
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$5,264.75
Rate for Payer: Aetna Commercial	$3,158.85
Rate for Payer: Aetna Medicare Advantage	$3,158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.02
Rate for Payer: Cigna Commercial	$5,264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CRF SZ 4 SDE LFT T

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270692360
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLONCRF SZE #4 LT TYP CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLONCRF SZE #4 LT TYP CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$3,158.84
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CRUCIATE RETAIN FEM

Facility

$11,762.20

Service Code	HCPCS C1713
Hospital Charge Code	270704901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.33
Max. Negotiated Rate	$2,846.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,352.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,846.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,764.33

TRIATHLON CRUCIATE RETAIN FEM

Facility

$11,762.20

Service Code	HCPCS C1713
Hospital Charge Code	270704901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.33
Max. Negotiated Rate	$5,881.10
Rate for Payer: Aetna Commercial	$3,528.66
Rate for Payer: Aetna Medicare Advantage	$3,528.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,999.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,999.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,352.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,999.36
Rate for Payer: Cigna Commercial	$5,881.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,846.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,764.33

TRIATHLON CRUC RET FEM SZ6 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692910
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CRUC RET FEM SZ6 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692910
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$3,158.84
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CRUC RET FEM SZ7 RT

Facility

$8,844.75

Service Code	HCPCS C1776
Hospital Charge Code	270693063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.71
Max. Negotiated Rate	$2,140.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,140.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.71

Know your out-of-pocket cost for care.

All Charges