Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$4,422.38
Rate for Payer: Aetna Commercial	$2,653.43
Rate for Payer: Aetna Medicare Advantage	$2,653.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,255.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,255.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,255.41
Rate for Payer: Cigna Commercial	$4,422.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,140.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.71

TRIATHLON CRU RET FEM CR SZ5LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691178
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 CRU RET FEM CR SZ5LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691178
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 FEMORAL CR SZ3

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270697037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.65
Max. Negotiated Rate	$3,618.82
Rate for Payer: Aetna Commercial	$2,171.30
Rate for Payer: Aetna Medicare Advantage	$2,171.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.60
Rate for Payer: Cigna Commercial	$3,618.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65

TRIATHLON FEMORAL CR SZ3

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270697037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.65
Max. Negotiated Rate	$1,751.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65

TRIATHLON FEM STAB PS SZ4 LT

Facility

$7,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270691263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$1,830.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75

TRIATHLON FEM STAB PS SZ4 LT

Facility

$7,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270691263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$3,782.50
Rate for Payer: Aetna Commercial	$2,269.50
Rate for Payer: Aetna Medicare Advantage	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,929.08
Rate for Payer: Cigna Commercial	$3,782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75

TRIATHLON FEMUR CR SZ 2 LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697481
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 FEMUR CR SZ 2 LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697481
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 FEMUR PS SZ 2 LT

Facility

$6,531.90

Service Code	HCPCS C1776
Hospital Charge Code	270697487
Hospital Revenue Code	278
Min. Negotiated Rate	$979.78
Max. Negotiated Rate	$3,265.95
Rate for Payer: Aetna Commercial	$1,959.57
Rate for Payer: Aetna Medicare Advantage	$1,959.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.63
Rate for Payer: Cigna Commercial	$3,265.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.72
Rate for Payer: Qualcare PPO/HMO/WC	$979.78

TRIATHLON FEMUR PS SZ 2 LT

Facility

$6,531.90

Service Code	HCPCS C1776
Hospital Charge Code	270697487
Hospital Revenue Code	278
Min. Negotiated Rate	$979.78
Max. Negotiated Rate	$1,580.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.72
Rate for Payer: Qualcare PPO/HMO/WC	$979.78

TRIATHLON INSERT 11MM SZ3

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270692430
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$7,177.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

TRIATHLON INSERT 11MM SZ3

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270692430
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$5,789.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

TRIATHLON METAL PATELLA A38X11

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270692853
Hospital Revenue Code	278
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$1,275.25
Rate for Payer: Aetna Commercial	$765.15
Rate for Payer: Aetna Medicare Advantage	$765.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.38
Rate for Payer: Cigna Commercial	$1,275.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Qualcare PPO/HMO/WC	$382.57

TRIATHLON METAL PATELLA A38X11

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270692853
Hospital Revenue Code	278
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$617.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Qualcare PPO/HMO/WC	$382.57

TRIATHLON PATELLA SZ 3 PS LT

Facility

$2,100.65

Service Code	HCPCS C1776
Hospital Charge Code	270697928
Hospital Revenue Code	278
Min. Negotiated Rate	$315.10
Max. Negotiated Rate	$1,050.33
Rate for Payer: Aetna Commercial	$630.20
Rate for Payer: Aetna Medicare Advantage	$630.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.67
Rate for Payer: Cigna Commercial	$1,050.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.36
Rate for Payer: Qualcare PPO/HMO/WC	$315.10

TRIATHLON PATELLA SZ 3 PS LT

Facility

$2,100.65

Service Code	HCPCS C1776
Hospital Charge Code	270697928
Hospital Revenue Code	278
Min. Negotiated Rate	$315.10
Max. Negotiated Rate	$508.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.36
Rate for Payer: Qualcare PPO/HMO/WC	$315.10

TRIATHLON PS FEM COMP LT SZ3

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270694445
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$5,387.18
Rate for Payer: Aetna Commercial	$3,232.30
Rate for Payer: Aetna Medicare Advantage	$3,232.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.46
Rate for Payer: Cigna Commercial	$5,387.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

TRIATHLON PS FEM COMP LT SZ3

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270694445
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$2,607.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

TRIATHLON PS FEM COMPON LT PS7

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

TRIATHLON PS FEM COMPON LT PS7

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,171.37
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

TRIATHLON PSF PS RT SZ7

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270697091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$5,387.18
Rate for Payer: Aetna Commercial	$3,232.30
Rate for Payer: Aetna Medicare Advantage	$3,232.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.46
Rate for Payer: Cigna Commercial	$5,387.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

TRIATHLON PSF PS RT SZ7

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270697091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$2,607.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

TRIATHLON TBI CS SZ1 11MM

Facility

$5,082.30

Service Code	HCPCS C1776
Hospital Charge Code	270696480
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.92
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIATHLON TBI CS SZ1 11MM

Facility

$5,082.30

Service Code	HCPCS C1776
Hospital Charge Code	270696480
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$2,541.15
Rate for Payer: Aetna Commercial	$1,524.69
Rate for Payer: Aetna Medicare Advantage	$1,524.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,295.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,295.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,295.99
Rate for Payer: Cigna Commercial	$2,541.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.92
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

Know your out-of-pocket cost for care.

All Charges