Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRIDENT 10X3 INSERT 36MM ID

Facility

$4,203.25

Service Code	HCPCS C1776
Hospital Charge Code	270692857
Hospital Revenue Code	278
Min. Negotiated Rate	$630.49
Max. Negotiated Rate	$2,101.62
Rate for Payer: Aetna Commercial	$1,260.97
Rate for Payer: Aetna Medicare Advantage	$1,260.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.83
Rate for Payer: Cigna Commercial	$2,101.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.19
Rate for Payer: Qualcare PPO/HMO/WC	$630.49

TRIDENT 10X3 INSERT 36MM ID

Facility

$4,203.25

Service Code	HCPCS C1776
Hospital Charge Code	270692857
Hospital Revenue Code	278
Min. Negotiated Rate	$630.49
Max. Negotiated Rate	$1,017.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.19
Rate for Payer: Qualcare PPO/HMO/WC	$630.49

TRIDENT II TI CLUST ACET SHELL

Facility

$6,562.50

Service Code	HCPCS C1776
Hospital Charge Code	270686576
Hospital Revenue Code	278
Min. Negotiated Rate	$984.38
Max. Negotiated Rate	$3,281.25
Rate for Payer: Aetna Commercial	$1,968.75
Rate for Payer: Aetna Medicare Advantage	$1,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,673.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,673.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,673.44
Rate for Payer: Cigna Commercial	$3,281.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.12
Rate for Payer: Qualcare PPO/HMO/WC	$984.38

TRIDENT II TI CLUST ACET SHELL

Facility

$6,562.50

Service Code	HCPCS C1776
Hospital Charge Code	270686576
Hospital Revenue Code	278
Min. Negotiated Rate	$984.38
Max. Negotiated Rate	$1,588.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.12
Rate for Payer: Qualcare PPO/HMO/WC	$984.38

TRIDENT II TRITANIUM CLUSTERHO

Facility

$20,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270684555
Hospital Revenue Code	278
Min. Negotiated Rate	$3,047.25
Max. Negotiated Rate	$4,916.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,063.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,916.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,047.25

TRIDENT II TRITANIUM CLUSTERHO

Facility

$20,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270684555
Hospital Revenue Code	278
Min. Negotiated Rate	$3,047.25
Max. Negotiated Rate	$10,157.50
Rate for Payer: Aetna Commercial	$6,094.50
Rate for Payer: Aetna Medicare Advantage	$6,094.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,180.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,180.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,180.32
Rate for Payer: Cigna Commercial	$10,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,916.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,047.25

TRIDENT II TRITAN SOLIDBK 56F

Facility

$5,888.55

Service Code	HCPCS C1776
Hospital Charge Code	270699331
Hospital Revenue Code	278
Min. Negotiated Rate	$883.28
Max. Negotiated Rate	$1,425.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.03
Rate for Payer: Qualcare PPO/HMO/WC	$883.28

TRIDENT II TRITAN SOLIDBK 56F

Facility

$5,888.55

Service Code	HCPCS C1776
Hospital Charge Code	270699331
Hospital Revenue Code	278
Min. Negotiated Rate	$883.28
Max. Negotiated Rate	$2,944.28
Rate for Payer: Aetna Commercial	$1,766.57
Rate for Payer: Aetna Medicare Advantage	$1,766.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.58
Rate for Payer: Cigna Commercial	$2,944.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.03
Rate for Payer: Qualcare PPO/HMO/WC	$883.28

TRIDENT II TRITAN SOLIDBK 60G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$2,973.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

TRIDENT II TRITAN SOLIDBK 60G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$6,143.75
Rate for Payer: Aetna Commercial	$3,686.25
Rate for Payer: Aetna Medicare Advantage	$3,686.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,133.31
Rate for Payer: Cigna Commercial	$6,143.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

TRIDENT LINER X3 10D INST 36MM

Facility

$4,275.85

Service Code	HCPCS C1776
Hospital Charge Code	270692859
Hospital Revenue Code	278
Min. Negotiated Rate	$641.38
Max. Negotiated Rate	$2,137.93
Rate for Payer: Aetna Commercial	$1,282.76
Rate for Payer: Aetna Medicare Advantage	$1,282.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.34
Rate for Payer: Cigna Commercial	$2,137.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.76
Rate for Payer: Qualcare PPO/HMO/WC	$641.38

TRIDENT LINER X3 10D INST 36MM

Facility

$4,275.85

Service Code	HCPCS C1776
Hospital Charge Code	270692859
Hospital Revenue Code	278
Min. Negotiated Rate	$641.38
Max. Negotiated Rate	$1,034.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.76
Rate for Payer: Qualcare PPO/HMO/WC	$641.38

TRIDENTX3 10DPOLY INSERT 36MMG

Facility

$4,458.50

Service Code	HCPCS C1776
Hospital Charge Code	270695399
Hospital Revenue Code	278
Min. Negotiated Rate	$668.77
Max. Negotiated Rate	$2,229.25
Rate for Payer: Aetna Commercial	$1,337.55
Rate for Payer: Aetna Medicare Advantage	$1,337.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.92
Rate for Payer: Cigna Commercial	$2,229.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.96
Rate for Payer: Qualcare PPO/HMO/WC	$668.77

TRIDENTX3 10DPOLY INSERT 36MMG

Facility

$4,458.50

Service Code	HCPCS C1776
Hospital Charge Code	270695399
Hospital Revenue Code	278
Min. Negotiated Rate	$668.77
Max. Negotiated Rate	$1,078.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.96
Rate for Payer: Qualcare PPO/HMO/WC	$668.77

TRIDESILON .05% OINT/15GM

Facility

$61.00

Hospital Charge Code	60634301
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

TRIDESILON .05% OINT/15GM

Facility

$61.00

Hospital Charge Code	60634301
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

TRIDIL/5MG/1ML

Facility

$48.00

Hospital Charge Code	60634065
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TRIDIL/5MG/1ML

Facility

$48.00

Hospital Charge Code	60634065
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

TRIDIL STARTER KIT/50MG/1

Facility

$104.00

Hospital Charge Code	60634066
Hospital Revenue Code	250
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

TRIDIL STARTER KIT/50MG/1

Facility

$104.00

Hospital Charge Code	60634066
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

TRIDIL STARTER KIT/50MG/1

Facility

$95.00

Hospital Charge Code	60634067
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

TRIDIL STARTER KIT/50MG/1

Facility

$95.00

Hospital Charge Code	60634067
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

TRIDILVIP/50MG/VIAL

Facility

$101.00

Hospital Charge Code	60634268
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

TRIDILVIP/50MG/VIAL

Facility

$101.00

Hospital Charge Code	60634268
Hospital Revenue Code	250
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$50.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$50.50

TRIDTIIPSLCLUSTHOLEHAACESH52MM

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270691240
Hospital Revenue Code	278
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$1,153.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,153.13
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

Know your out-of-pocket cost for care.

All Charges