Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT BIOBRACE 5X25MM

Facility

$12,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270699462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

GRAFT BIOBRACE 5X25MM

Facility

$12,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270699462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$3,862.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

GRAFT BIOCORE MOLDABLE100X20MM

Facility

$23,079.00

Service Code	HCPCS C1713
Hospital Charge Code	270699954
Hospital Revenue Code	278
Min. Negotiated Rate	$3,461.85
Max. Negotiated Rate	$11,539.50
Rate for Payer: Aetna Commercial	$6,923.70
Rate for Payer: Aetna Medicare Advantage	$6,923.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,885.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,885.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,615.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,885.15
Rate for Payer: Cigna Commercial	$11,539.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,585.12
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.85

GRAFT BIOCORE MOLDABLE100X20MM

Facility

$23,079.00

Service Code	HCPCS C1713
Hospital Charge Code	270699954
Hospital Revenue Code	278
Min. Negotiated Rate	$3,461.85
Max. Negotiated Rate	$5,585.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,615.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,585.12
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.85

GRAFT BIO DBM PUTTY PLUS 5CC

Facility

$11,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270693378
Hospital Revenue Code	278
Min. Negotiated Rate	$1,670.25
Max. Negotiated Rate	$2,694.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,694.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,670.25

GRAFT BIO DBM PUTTY PLUS 5CC

Facility

$11,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270693378
Hospital Revenue Code	278
Min. Negotiated Rate	$1,670.25
Max. Negotiated Rate	$5,567.50
Rate for Payer: Aetna Commercial	$3,340.50
Rate for Payer: Aetna Medicare Advantage	$3,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,839.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,839.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,839.43
Rate for Payer: Cigna Commercial	$5,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,694.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,670.25

GRAFT BIOD RESTORE S

Facility

$1,705.00

Service Code	HCPCS C1763
Hospital Charge Code	270684070
Hospital Revenue Code	278
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$852.50
Rate for Payer: Aetna Commercial	$511.50
Rate for Payer: Aetna Medicare Advantage	$511.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.77
Rate for Payer: Cigna Commercial	$852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: Qualcare PPO/HMO/WC	$255.75

GRAFT BIOD RESTORE S

Facility

$1,705.00

Service Code	HCPCS C1763
Hospital Charge Code	270684070
Hospital Revenue Code	278
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$412.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: Qualcare PPO/HMO/WC	$255.75

GRAFT BOLT 8.5X30MM

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705798
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,537.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

GRAFT BOLT 8.5X30MM

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705798
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

GRAFT BONE AUGMENT REG 1.5CC

Facility

$12,350.00

Service Code	HCPCS C1734
Hospital Charge Code	270697750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,852.50
Max. Negotiated Rate	$2,988.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,988.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,852.50

GRAFT BONE AUGMENT REG 1.5CC

Facility

$12,350.00

Service Code	HCPCS C1734
Hospital Charge Code	270697750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,852.50
Max. Negotiated Rate	$6,175.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$3,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,149.25
Rate for Payer: Cigna Commercial	$6,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,988.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,852.50

GRAFT BONE BIOCORE 50X20MM

Facility

$16,578.00

Service Code	HCPCS C1713
Hospital Charge Code	270698070
Hospital Revenue Code	278
Min. Negotiated Rate	$2,486.70
Max. Negotiated Rate	$8,289.00
Rate for Payer: Aetna Commercial	$4,973.40
Rate for Payer: Aetna Medicare Advantage	$4,973.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,227.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,227.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,227.39
Rate for Payer: Cigna Commercial	$8,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,011.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,486.70

GRAFT BONE BIOCORE 50X20MM

Facility

$16,578.00

Service Code	HCPCS C1713
Hospital Charge Code	270698070
Hospital Revenue Code	278
Min. Negotiated Rate	$2,486.70
Max. Negotiated Rate	$4,011.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,315.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,011.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,486.70

GRAFT BONE GENEX 10CC

Facility

$13,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696121
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

GRAFT BONE GENEX 10CC

Facility

$13,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696121
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$4,192.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

GRAFT BONE MAGNETOS 10CC 1-2MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$4,875.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

GRAFT BONE MAGNETOS 10CC 1-2MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

GRAFT BONE MAGNETOS 5CC 1-2MM

Facility

$8,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$2,437.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

GRAFT BONE MAGNETOS 5CC 1-2MM

Facility

$8,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

GRAFT BONE MATRIX COLLAGRAFT

Facility

$3,501.85

Hospital Charge Code	270610062
Hospital Revenue Code	278
Min. Negotiated Rate	$525.28
Max. Negotiated Rate	$847.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.45
Rate for Payer: Qualcare PPO/HMO/WC	$525.28

GRAFT BONE MATRIX COLLAGRAFT

Facility

$3,501.85

Hospital Charge Code	270610062
Hospital Revenue Code	278
Min. Negotiated Rate	$525.28
Max. Negotiated Rate	$1,750.92
Rate for Payer: Aetna Commercial	$1,050.56
Rate for Payer: Aetna Medicare Advantage	$1,050.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.97
Rate for Payer: Cigna Commercial	$1,750.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.45
Rate for Payer: Qualcare PPO/HMO/WC	$525.28

GRAFT BONE MATRIX LG KT

Facility

$1,645.65

Hospital Charge Code	270605572
Hospital Revenue Code	278
Min. Negotiated Rate	$246.85
Max. Negotiated Rate	$398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$329.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$398.25
Rate for Payer: Qualcare PPO/HMO/WC	$246.85

GRAFT BONE MATRIX LG KT

Facility

$1,645.65

Hospital Charge Code	270605572
Hospital Revenue Code	278
Min. Negotiated Rate	$246.85
Max. Negotiated Rate	$822.83
Rate for Payer: Aetna Commercial	$493.69
Rate for Payer: Aetna Medicare Advantage	$493.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$419.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$419.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$419.64
Rate for Payer: Cigna Commercial	$822.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$398.25
Rate for Payer: Qualcare PPO/HMO/WC	$246.85

GRAFT BONE OSTEOMATRIX OMCS10

Facility

$4,987.50

Hospital Charge Code	270646938
Hospital Revenue Code	278
Min. Negotiated Rate	$748.12
Max. Negotiated Rate	$2,493.75
Rate for Payer: Aetna Commercial	$1,496.25
Rate for Payer: Aetna Medicare Advantage	$1,496.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.81
Rate for Payer: Cigna Commercial	$2,493.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.97
Rate for Payer: Qualcare PPO/HMO/WC	$748.12

Know your out-of-pocket cost for care.

All Charges