Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIATHLON X3 TBI PS 7 X 9MM

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691171
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TRIATHLON X3 TBI SZ 5 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691177
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

TRIATHLON X3 TBI SZ 5 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691177
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

TRIATHLON X3 TBI SZ6 CS 11MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692909
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

TRIATHLON X3 TBI SZ6 CS 11MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692909
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

TRIATHLON X3 TIBIAL BEARING 13

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270694783
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

TRIATHLON X3 TIBIAL BEARING 13

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270694783
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

TRIATH TIBINSX3 TS TI SZ3 11MM

Facility

$5,542.30

Service Code	HCPCS C1776
Hospital Charge Code	270697488
Hospital Revenue Code	278
Min. Negotiated Rate	$831.35
Max. Negotiated Rate	$1,341.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,108.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,341.24
Rate for Payer: Qualcare PPO/HMO/WC	$831.35

TRIATH TIBINSX3 TS TI SZ3 11MM

Facility

$5,542.30

Service Code	HCPCS C1776
Hospital Charge Code	270697488
Hospital Revenue Code	278
Min. Negotiated Rate	$831.35
Max. Negotiated Rate	$2,771.15
Rate for Payer: Aetna Commercial	$1,662.69
Rate for Payer: Aetna Medicare Advantage	$1,662.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,413.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,413.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,108.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,413.29
Rate for Payer: Cigna Commercial	$2,771.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,341.24
Rate for Payer: Qualcare PPO/HMO/WC	$831.35

TRIATH TRITAN BSPLT SZ2

Facility

$6,837.05

Service Code	HCPCS C1776
Hospital Charge Code	270693814
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.56
Max. Negotiated Rate	$3,418.53
Rate for Payer: Aetna Commercial	$2,051.11
Rate for Payer: Aetna Medicare Advantage	$2,051.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.45
Rate for Payer: Cigna Commercial	$3,418.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.56

TRIATH TRITAN BSPLT SZ2

Facility

$6,837.05

Service Code	HCPCS C1776
Hospital Charge Code	270693814
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.56
Max. Negotiated Rate	$1,654.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.56

TRIATH X3 SYM PATELLA 8MM-CAP

Facility

$2,200.15

Service Code	HCPCS C1776
Hospital Charge Code	270692888
Hospital Revenue Code	278
Min. Negotiated Rate	$330.02
Max. Negotiated Rate	$1,100.08
Rate for Payer: Aetna Commercial	$660.04
Rate for Payer: Aetna Medicare Advantage	$660.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.04
Rate for Payer: Cigna Commercial	$1,100.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.44
Rate for Payer: Qualcare PPO/HMO/WC	$330.02

TRIATH X3 SYM PATELLA 8MM-CAP

Facility

$2,200.15

Service Code	HCPCS C1776
Hospital Charge Code	270692888
Hospital Revenue Code	278
Min. Negotiated Rate	$330.02
Max. Negotiated Rate	$532.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.44
Rate for Payer: Qualcare PPO/HMO/WC	$330.02

TRIATH X3 TBI CS 11MM SZ2-CAP

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692887
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

TRIATH X3 TBI CS 11MM SZ2-CAP

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692887
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

TRIAVIL 2-10/TAB

Facility

$5.00

Hospital Charge Code	60634062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

TRIAVIL 2-10/TAB

Facility

$5.00

Hospital Charge Code	60634062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TRIAVIL 2-25

Facility

$3.00

Hospital Charge Code	60634679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

TRIAVIL 2-25

Facility

$3.00

Hospital Charge Code	60634679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 2-25/UD

Facility

$3.00

Hospital Charge Code	60634680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 2-25/UD

Facility

$3.00

Hospital Charge Code	60634680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

TRIAVIL 4-10/TAB

Facility

$3.00

Hospital Charge Code	60634405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 4-10/TAB

Facility

$3.00

Hospital Charge Code	60634405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

TRIAVIL 4-10/UD

Facility

$3.00

Hospital Charge Code	60634681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 4-10/UD

Facility

$3.00

Hospital Charge Code	60634681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

Know your out-of-pocket cost for care.

All Charges