Heights University Hospital

All Charges

Charge

Type

Setting

Price

FACET JOINT BLOCK 1ST LEVEL

Facility

$2,043.00

Service Code	HCPCS 64475
Hospital Charge Code	84506035
Hospital Revenue Code	361
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

FACET JOINT BLOCK 1ST LEVEL

Facility

$2,043.00

Service Code	HCPCS 64475
Hospital Charge Code	84506035
Hospital Revenue Code	361
Min. Negotiated Rate	$265.59
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$612.90
Rate for Payer: Aetna Medicare Advantage	$612.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.97
Rate for Payer: Cigna Commercial	$1,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.59
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

FACET JOINT BLOCK EA ADD'L LVL

Facility

$1,905.00

Service Code	HCPCS 64476
Hospital Charge Code	84506040
Hospital Revenue Code	361
Min. Negotiated Rate	$247.65
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$571.50
Rate for Payer: Aetna Medicare Advantage	$571.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$485.77
Rate for Payer: Cigna Commercial	$952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.65
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

FACET JOINT BLOCK EA ADD'L LVL

Facility

$1,905.00

Service Code	HCPCS 64476
Hospital Charge Code	84506040
Hospital Revenue Code	361
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$285.75
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

FACET SCREW 4.5X25MM

Facility

$4,975.00

Hospital Charge Code	270702453
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,492.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACET SCREW 4.5X25MM

Facility

$4,975.00

Hospital Charge Code	270702453
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACET SCREW 4.5X30MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703887
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X30MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703887
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X40MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703886
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X40MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703886
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X45MM

Facility

$4,975.00

Hospital Charge Code	270702454
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,492.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACET SCREW 4.5X45MM

Facility

$4,975.00

Hospital Charge Code	270702454
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$22,600.69

Service Code	APR-DRG 0922
Min. Negotiated Rate	$15,578.41
Max. Negotiated Rate	$22,600.69
Rate for Payer: Aetna Better Health Medicaid	$22,157.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,600.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15,578.41

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$17,669.93

Service Code	APR-DRG 0921
Min. Negotiated Rate	$11,175.41
Max. Negotiated Rate	$17,669.93
Rate for Payer: Aetna Better Health Medicaid	$17,323.46
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,669.93
Rate for Payer: Wellpoint Medicaid Managed Care	$11,175.41

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$35,275.21

Service Code	APR-DRG 0923
Min. Negotiated Rate	$24,612.36
Max. Negotiated Rate	$35,275.21
Rate for Payer: Aetna Better Health Medicaid	$34,583.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,275.21
Rate for Payer: Wellpoint Medicaid Managed Care	$24,612.36

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$63,305.26

Service Code	APR-DRG 0924
Min. Negotiated Rate	$48,910.86
Max. Negotiated Rate	$63,305.26
Rate for Payer: Aetna Better Health Medicaid	$62,063.98
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$63,305.26
Rate for Payer: Wellpoint Medicaid Managed Care	$48,910.86

FACIAL BONES COMPL

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	94061005
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FACIAL BONES COMPL

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	94061005
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08

FACTOR 8 PER VIAL

Facility

$9.00

Hospital Charge Code	38471089
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR 8 PER VIAL

Facility

$9.00

Hospital Charge Code	38471089
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR 9 PER VIAL

Facility

$9.00

Hospital Charge Code	38471091
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR 9 PER VIAL

Facility

$9.00

Hospital Charge Code	38471091
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR II

Facility

$214.00

Service Code	HCPCS 85210
Hospital Charge Code	38478032
Hospital Revenue Code	305
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

FACTOR II

Facility

$214.00

Service Code	HCPCS 85210
Hospital Charge Code	38478032
Hospital Revenue Code	305
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.06
Rate for Payer: Aetna Medicare Advantage	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.56
Rate for Payer: Cigna Commercial	$12.98
Rate for Payer: Cigna Medicare Advantage	$6.49
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.76
Rate for Payer: Wellcare Medicare Advantage	$12.98

FACTOR II ACTIVITY

Facility

$390.00

Service Code	HCPCS 85210
Hospital Charge Code	39900344
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges