Heights University Hospital

All Charges

Charge

Type

Setting

Price

BONE DENSITY DEXA APP SKELETON

Facility

$607.50

Service Code	HCPCS 77081
Hospital Charge Code	2709001
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

BONE DENSITY DEXA APP SKELETON

Facility

$607.50

Service Code	HCPCS 77081
Hospital Charge Code	2709001
Hospital Revenue Code	320
Min. Negotiated Rate	$78.97
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

BONE DENSITY DEXA FOREARM BMD

Facility

$607.50

Service Code	HCPCS 77081
Hospital Charge Code	2709003
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

BONE DENSITY DEXA FOREARM BMD

Facility

$607.50

Service Code	HCPCS 77081
Hospital Charge Code	2709003
Hospital Revenue Code	320
Min. Negotiated Rate	$78.97
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$49,448.28

Service Code	MSDRG 553
Min. Negotiated Rate	$14,145.98
Max. Negotiated Rate	$49,448.28
Rate for Payer: Aetna Commercial	$43,711.08
Rate for Payer: Aetna Medicare Advantage	$14,145.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,215.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,215.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,482.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,215.45
Rate for Payer: Cigna Commercial	$27,897.67
Rate for Payer: Cigna Medicare Advantage	$16,482.76
Rate for Payer: Clover Medicare Advantage	$15,658.62
Rate for Payer: EmblemHealth Commercial	$49,448.28
Rate for Payer: Humana Medicare Advantage	$16,977.24
Rate for Payer: Oxford Commercial	$17,435.24
Rate for Payer: UnitedHealthcare Commercial	$19,790.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,482.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17,471.73
Rate for Payer: Wellcare Medicare Advantage	$16,482.76

BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility

$35,916.48

Service Code	MSDRG 554
Min. Negotiated Rate	$9,058.54
Max. Negotiated Rate	$35,916.48
Rate for Payer: Aetna Commercial	$27,990.89
Rate for Payer: Aetna Medicare Advantage	$9,058.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,604.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,604.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,972.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,604.94
Rate for Payer: Cigna Commercial	$17,864.58
Rate for Payer: Cigna Medicare Advantage	$11,972.16
Rate for Payer: Clover Medicare Advantage	$11,373.55
Rate for Payer: EmblemHealth Commercial	$35,916.48
Rate for Payer: Humana Medicare Advantage	$12,331.32
Rate for Payer: Oxford Commercial	$11,164.84
Rate for Payer: UnitedHealthcare Commercial	$12,673.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,972.16
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,690.49
Rate for Payer: Wellcare Medicare Advantage	$11,972.16

BONE DOWEL 10MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270686213
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

BONE DOWEL 10MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270686213
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,466.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

BONE DOWEL 9MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270686212
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,466.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

BONE DOWEL 9MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270686212
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

BONE DOWEL REVISION KIT 18MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695354
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

BONE DOWEL REVISION KIT 18MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695354
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$825.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

BONE DRILL 3.0

Facility

$676.40

Hospital Charge Code	270670675
Hospital Revenue Code	272
Min. Negotiated Rate	$87.93
Max. Negotiated Rate	$338.20
Rate for Payer: Aetna Commercial	$202.92
Rate for Payer: Aetna Medicare Advantage	$202.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.48
Rate for Payer: Cigna Commercial	$338.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.93
Rate for Payer: Oxford Commercial	$338.20
Rate for Payer: Qualcare PPO/HMO/WC	$101.46
Rate for Payer: UnitedHealthcare Commercial	$338.20

BONE DRILL 3.0

Facility

$676.40

Hospital Charge Code	270670675
Hospital Revenue Code	272
Min. Negotiated Rate	$101.46
Max. Negotiated Rate	$101.46
Rate for Payer: Qualcare PPO/HMO/WC	$101.46

BONE EBI MORS CORT 20CC 450692

Facility

$1,271.10

Hospital Charge Code	270628790
Hospital Revenue Code	272
Min. Negotiated Rate	$165.24
Max. Negotiated Rate	$635.55
Rate for Payer: Aetna Commercial	$381.33
Rate for Payer: Aetna Medicare Advantage	$381.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$324.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$324.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$324.13
Rate for Payer: Cigna Commercial	$635.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.24
Rate for Payer: Oxford Commercial	$635.55
Rate for Payer: Qualcare PPO/HMO/WC	$190.66
Rate for Payer: UnitedHealthcare Commercial	$635.55

BONE EBI MORS CORT 20CC 450692

Facility

$1,271.10

Hospital Charge Code	270628790
Hospital Revenue Code	272
Min. Negotiated Rate	$190.66
Max. Negotiated Rate	$190.66
Rate for Payer: Qualcare PPO/HMO/WC	$190.66

BONE FENESTRATION PERFORATOR

Facility

$877.50

Hospital Charge Code	270699686
Hospital Revenue Code	278
Min. Negotiated Rate	$131.62
Max. Negotiated Rate	$438.75
Rate for Payer: Aetna Commercial	$263.25
Rate for Payer: Aetna Medicare Advantage	$263.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.76
Rate for Payer: Cigna Commercial	$438.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.35
Rate for Payer: Qualcare PPO/HMO/WC	$131.62

BONE FENESTRATION PERFORATOR

Facility

$877.50

Hospital Charge Code	270699686
Hospital Revenue Code	278
Min. Negotiated Rate	$131.62
Max. Negotiated Rate	$212.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.35
Rate for Payer: Qualcare PPO/HMO/WC	$131.62

BONE FILLER 10 CC

Facility

$19,337.50

Service Code	HCPCS C1713
Hospital Charge Code	270701671
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.62
Max. Negotiated Rate	$9,668.75
Rate for Payer: Aetna Commercial	$5,801.25
Rate for Payer: Aetna Medicare Advantage	$5,801.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,931.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,931.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,867.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,931.06
Rate for Payer: Cigna Commercial	$9,668.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,679.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,900.62

BONE FILLER 10 CC

Facility

$19,337.50

Service Code	HCPCS C1713
Hospital Charge Code	270701671
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.62
Max. Negotiated Rate	$4,679.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,679.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,900.62

BONE FILLER 5ML CERAMENT

Facility

$6,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270690281
Hospital Revenue Code	278
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$1,579.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

BONE FILLER 5ML CERAMENT

Facility

$6,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270690281
Hospital Revenue Code	278
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$3,262.50
Rate for Payer: Aetna Commercial	$1,957.50
Rate for Payer: Aetna Medicare Advantage	$1,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.88
Rate for Payer: Cigna Commercial	$3,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

BONE GRAFT 10CC INJECTABLE

Facility

$14,615.00

Hospital Charge Code	270667747
Hospital Revenue Code	278
Min. Negotiated Rate	$2,192.25
Max. Negotiated Rate	$7,307.50
Rate for Payer: Aetna Commercial	$4,384.50
Rate for Payer: Aetna Medicare Advantage	$4,384.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,923.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.82
Rate for Payer: Cigna Commercial	$7,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,536.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.25

BONE GRAFT 10CC INJECTABLE

Facility

$14,615.00

Hospital Charge Code	270667747
Hospital Revenue Code	278
Min. Negotiated Rate	$2,192.25
Max. Negotiated Rate	$3,536.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,923.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,536.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.25

BONE GRAFT 4CC INJECTABLE

Facility

$7,230.00

Service Code	HCPCS C1713
Hospital Charge Code	270656818
Hospital Revenue Code	278
Min. Negotiated Rate	$1,084.50
Max. Negotiated Rate	$3,615.00
Rate for Payer: Aetna Commercial	$2,169.00
Rate for Payer: Aetna Medicare Advantage	$2,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,843.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,843.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,843.65
Rate for Payer: Cigna Commercial	$3,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,749.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,084.50

Know your out-of-pocket cost for care.

All Charges