Heights University Hospital

All Charges

Charge

Type

Setting

Price

SP BONE AGRFT MORSEL ADD-ON

Facility

$6,322.68

Service Code	HCPCS 20937
Hospital Charge Code	16000603
Hospital Revenue Code	360
Min. Negotiated Rate	$948.40
Max. Negotiated Rate	$948.40
Rate for Payer: Qualcare PPO/HMO/WC	$948.40

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	162004
Hospital Revenue Code	360
Min. Negotiated Rate	$1,783.08
Max. Negotiated Rate	$1,783.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	16000253
Hospital Revenue Code	360
Min. Negotiated Rate	$1,487.00
Max. Negotiated Rate	$5,943.61
Rate for Payer: Aetna Commercial	$3,566.17
Rate for Payer: Aetna Medicare Advantage	$3,566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,031.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,031.24
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	$3,031.24
Rate for Payer: Cigna Commercial	$5,943.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,545.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	16000253
Hospital Revenue Code	360
Min. Negotiated Rate	$1,783.08
Max. Negotiated Rate	$1,783.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08

SP BONE ALGRFT MORSEL ADD-ON

Facility

$11,887.22

Service Code	HCPCS 20930
Hospital Charge Code	162004
Hospital Revenue Code	360
Min. Negotiated Rate	$1,487.00
Max. Negotiated Rate	$5,943.61
Rate for Payer: Aetna Commercial	$3,566.17
Rate for Payer: Aetna Medicare Advantage	$3,566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,031.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,031.24
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	$3,031.24
Rate for Payer: Cigna Commercial	$5,943.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,545.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

SP BONE ALGRFT STRUCT ADD - ON

Facility

$25,282.63

Service Code	HCPCS 20931
Hospital Charge Code	16000669
Hospital Revenue Code	360
Min. Negotiated Rate	$3,792.39
Max. Negotiated Rate	$3,792.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39

SP BONE ALGRFT STRUCT ADD - ON

Facility

$25,282.63

Service Code	HCPCS 20931
Hospital Charge Code	16000669
Hospital Revenue Code	360
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$7,584.79
Rate for Payer: Aetna Commercial	$7,584.79
Rate for Payer: Aetna Medicare Advantage	$7,584.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,447.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,447.07
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	$6,447.07
Rate for Payer: Cigna Commercial	$106.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.74
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,792.39
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

SP COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS 96125GN
Hospital Charge Code	9100145
Hospital Revenue Code	440
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$35.05
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$686.00

SP COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS 96125GN
Hospital Charge Code	9100145
Hospital Revenue Code	440
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

SPCR PLATEAU-C 8MM 37-1613-708

Facility

$5,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270698919
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$2,800.00
Rate for Payer: Aetna Commercial	$1,680.00
Rate for Payer: Aetna Medicare Advantage	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,428.00
Rate for Payer: Cigna Commercial	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: Qualcare PPO/HMO/WC	$840.00

SPCR PLATEAU-C 8MM 37-1613-708

Facility

$5,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270698919
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,355.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: Qualcare PPO/HMO/WC	$840.00

SPCR PRODISC INS TPS DP TM 6mm

Facility

$1,725.00

Service Code	HCPCS C1889
Hospital Charge Code	270693165
Hospital Revenue Code	278
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$517.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.45
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

SPCR PRODISC INS TPS DP TM 6mm

Facility

$1,725.00

Service Code	HCPCS C1889
Hospital Charge Code	270693165
Hospital Revenue Code	278
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$417.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.45
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

SPEAKING VALVE PURPLE

Facility

$532.05

Hospital Charge Code	270616940
Hospital Revenue Code	270
Min. Negotiated Rate	$69.17
Max. Negotiated Rate	$266.02
Rate for Payer: Aetna Commercial	$159.62
Rate for Payer: Aetna Medicare Advantage	$159.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.67
Rate for Payer: Cigna Commercial	$266.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.17
Rate for Payer: Oxford Commercial	$266.02
Rate for Payer: Qualcare PPO/HMO/WC	$79.81
Rate for Payer: UnitedHealthcare Commercial	$266.02

SPEAKING VALVE PURPLE

Facility

$532.05

Hospital Charge Code	270616940
Hospital Revenue Code	270
Min. Negotiated Rate	$79.81
Max. Negotiated Rate	$79.81
Rate for Payer: Qualcare PPO/HMO/WC	$79.81

SPEAR JUVENILE FLAT BLADE

Facility

$319.50

Hospital Charge Code	270655892
Hospital Revenue Code	271
Min. Negotiated Rate	$47.92
Max. Negotiated Rate	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$47.92

SPEAR JUVENILE FLAT BLADE

Facility

$319.50

Hospital Charge Code	270655892
Hospital Revenue Code	271
Min. Negotiated Rate	$41.53
Max. Negotiated Rate	$159.75
Rate for Payer: Aetna Commercial	$95.85
Rate for Payer: Aetna Medicare Advantage	$95.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.47
Rate for Payer: Cigna Commercial	$159.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.53
Rate for Payer: Oxford Commercial	$159.75
Rate for Payer: Qualcare PPO/HMO/WC	$47.92
Rate for Payer: UnitedHealthcare Commercial	$159.75

SPEAR SURGICAL

Facility

$1.00

Hospital Charge Code	270654191
Hospital Revenue Code	270
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

SPEAR SURGICAL

Facility

$1.00

Hospital Charge Code	270654191
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

SPEAR SURGICAL PVA

Facility

$567.40

Hospital Charge Code	270655872
Hospital Revenue Code	271
Min. Negotiated Rate	$85.11
Max. Negotiated Rate	$85.11
Rate for Payer: Qualcare PPO/HMO/WC	$85.11

SPEAR SURGICAL PVA

Facility

$567.40

Hospital Charge Code	270655872
Hospital Revenue Code	271
Min. Negotiated Rate	$73.76
Max. Negotiated Rate	$283.70
Rate for Payer: Aetna Commercial	$170.22
Rate for Payer: Aetna Medicare Advantage	$170.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.69
Rate for Payer: Cigna Commercial	$283.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.76
Rate for Payer: Oxford Commercial	$283.70
Rate for Payer: Qualcare PPO/HMO/WC	$85.11
Rate for Payer: UnitedHealthcare Commercial	$283.70

SPEAR SURGICAL STER

Facility

$13.65

Hospital Charge Code	270061270
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

SPEAR SURGICAL STER

Facility

$13.65

Hospital Charge Code	270061270
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

SPEC BOARD FOR SPEC MAMMOGRPHY

Facility

$77.65

Hospital Charge Code	1603588
Hospital Revenue Code	271
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

SPEC BOARD FOR SPEC MAMMOGRPHY

Facility

$77.65

Hospital Charge Code	1603588
Hospital Revenue Code	271
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$38.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$38.83

Know your out-of-pocket cost for care.

All Charges