Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT BONE OSTEOMATRIX OMCS10

Facility

$4,987.50

Hospital Charge Code	270646938
Hospital Revenue Code	278
Min. Negotiated Rate	$748.12
Max. Negotiated Rate	$1,206.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.97
Rate for Payer: Qualcare PPO/HMO/WC	$748.12

GRAFT BONE PASTE FD 5cc DBX

Facility

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	270679739
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$173.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.03
Rate for Payer: Qualcare PPO/HMO/WC	$107.25

GRAFT BONE PASTE FD 5cc DBX

Facility

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	270679739
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$357.50
Rate for Payer: Aetna Commercial	$214.50
Rate for Payer: Aetna Medicare Advantage	$214.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.32
Rate for Payer: Cigna Commercial	$357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.03
Rate for Payer: Qualcare PPO/HMO/WC	$107.25

GRAFT BONE SPACER 16MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270691814
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$6,450.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

GRAFT BONE SPACER 16MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270691814
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

GRAFT BONE SUBS ALTAPORE 1.6ML

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270693009
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$690.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

GRAFT BONE SUBS ALTAPORE 1.6ML

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270693009
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

GRAFT BONE SUBST GENEX 5CC

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

GRAFT BONE SUBST GENEX 5CC

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

GRAFT BONE/TENDON/BONE

Facility

$7,240.00

Hospital Charge Code	270607944
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.00
Max. Negotiated Rate	$1,752.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,752.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,086.00

GRAFT BONE/TENDON/BONE

Facility

$7,240.00

Hospital Charge Code	270607944
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.00
Max. Negotiated Rate	$3,620.00
Rate for Payer: Aetna Commercial	$2,172.00
Rate for Payer: Aetna Medicare Advantage	$2,172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,846.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,846.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,846.20
Rate for Payer: Cigna Commercial	$3,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,752.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,086.00

GRAFT CARTIFORM 10MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677098
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

GRAFT CARTIFORM 10MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677098
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

GRAFT CONDUIT 3MMX3CM NERVE

Facility

$6,482.50

Service Code	HCPCS C1889
Hospital Charge Code	270684389
Hospital Revenue Code	278
Min. Negotiated Rate	$972.38
Max. Negotiated Rate	$1,568.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.77
Rate for Payer: Qualcare PPO/HMO/WC	$972.38

GRAFT CONDUIT 3MMX3CM NERVE

Facility

$6,482.50

Service Code	HCPCS C1889
Hospital Charge Code	270684389
Hospital Revenue Code	278
Min. Negotiated Rate	$972.38
Max. Negotiated Rate	$3,241.25
Rate for Payer: Aetna Commercial	$1,944.75
Rate for Payer: Aetna Medicare Advantage	$1,944.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,653.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,653.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,653.04
Rate for Payer: Cigna Commercial	$3,241.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.77
Rate for Payer: Qualcare PPO/HMO/WC	$972.38

GRAFT CONDYL RT LATERAL

Facility

$56,000.00

Hospital Charge Code	270676320
Hospital Revenue Code	278
Min. Negotiated Rate	$8,400.00
Max. Negotiated Rate	$13,552.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,400.00

GRAFT CONDYL RT LATERAL

Facility

$56,000.00

Hospital Charge Code	270676320
Hospital Revenue Code	278
Min. Negotiated Rate	$8,400.00
Max. Negotiated Rate	$28,000.00
Rate for Payer: Aetna Commercial	$16,800.00
Rate for Payer: Aetna Medicare Advantage	$16,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,280.00
Rate for Payer: Cigna Commercial	$28,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,400.00

GRAFT CONTLATERL LIMB TFLE127

Facility

$14,320.00

Hospital Charge Code	270633904V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,148.00
Max. Negotiated Rate	$3,465.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00

GRAFT CONTLATERL LIMB TFLE127

Facility

$14,320.00

Hospital Charge Code	270633904V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,148.00
Max. Negotiated Rate	$7,160.00
Rate for Payer: Aetna Commercial	$4,296.00
Rate for Payer: Aetna Medicare Advantage	$4,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,651.60
Rate for Payer: Cigna Commercial	$7,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00

GRAFT CONTLATERL LIMB TFLE1271

Facility

$13,392.00

Hospital Charge Code	270633904
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$4,017.60
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRAFT CONTLATERL LIMB TFLE1271

Facility

$13,392.00

Hospital Charge Code	270633904
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRAFT CONTRA LEG PXC121400

Facility

$19,900.00

Hospital Charge Code	270635533V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,985.00
Max. Negotiated Rate	$9,950.00
Rate for Payer: Aetna Commercial	$5,970.00
Rate for Payer: Aetna Medicare Advantage	$5,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,074.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,074.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,074.50
Rate for Payer: Cigna Commercial	$9,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,815.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,985.00

GRAFT CONTRA LEG PXC121400

Facility

$16,303.60

Hospital Charge Code	270635533
Hospital Revenue Code	278
Min. Negotiated Rate	$2,445.54
Max. Negotiated Rate	$3,945.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,260.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,945.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,445.54

GRAFT CONTRA LEG PXC121400

Facility

$19,900.00

Hospital Charge Code	270635533V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,985.00
Max. Negotiated Rate	$4,815.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,815.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,985.00

GRAFT CONTRA LEG PXC121400

Facility

$16,303.60

Hospital Charge Code	270635533
Hospital Revenue Code	278
Min. Negotiated Rate	$2,445.54
Max. Negotiated Rate	$8,151.80
Rate for Payer: Aetna Commercial	$4,891.08
Rate for Payer: Aetna Medicare Advantage	$4,891.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,157.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,157.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,260.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,157.42
Rate for Payer: Cigna Commercial	$8,151.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,945.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,445.54

Know your out-of-pocket cost for care.

All Charges