Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,749.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,749.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,084.50

BONE GRAFT 5CC

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

BONE GRAFT 5CC

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

BONE GRAFT DELIV TUBE 10 CC

Facility

$693.00

Hospital Charge Code	270339051
Hospital Revenue Code	272
Min. Negotiated Rate	$90.09
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna Commercial	$207.90
Rate for Payer: Aetna Medicare Advantage	$207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.72
Rate for Payer: Cigna Commercial	$346.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.09
Rate for Payer: Oxford Commercial	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.95
Rate for Payer: UnitedHealthcare Commercial	$346.50

BONE GRAFT DELIV TUBE 10 CC

Facility

$693.00

Hospital Charge Code	270339051
Hospital Revenue Code	272
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$103.95
Rate for Payer: Qualcare PPO/HMO/WC	$103.95

BONE GRAFT GRAINS 10CC

Facility

$4,275.00

Hospital Charge Code	270671737
Hospital Revenue Code	278
Min. Negotiated Rate	$641.25
Max. Negotiated Rate	$1,034.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: Qualcare PPO/HMO/WC	$641.25

BONE GRAFT GRAINS 10CC

Facility

$4,275.00

Hospital Charge Code	270671737
Hospital Revenue Code	278
Min. Negotiated Rate	$641.25
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.12
Rate for Payer: Cigna Commercial	$2,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: Qualcare PPO/HMO/WC	$641.25

BONE GRAFT GRAINS 30CC

Facility

$13,000.00

Hospital Charge Code	270671738
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

BONE GRAFT GRAINS 30CC

Facility

$13,000.00

Hospital Charge Code	270671738
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$3,900.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

BONE GRAFT GRAINS 5CC

Facility

$2,250.00

Hospital Charge Code	270671736
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BONE GRAFT GRAINS 5CC

Facility

$2,250.00

Hospital Charge Code	270671736
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BONE GRAFT INQU GRANULES 10CC

Facility

$6,465.00

Hospital Charge Code	270671739
Hospital Revenue Code	278
Min. Negotiated Rate	$969.75
Max. Negotiated Rate	$1,564.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,293.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.53
Rate for Payer: Qualcare PPO/HMO/WC	$969.75

BONE GRAFT INQU GRANULES 10CC

Facility

$6,465.00

Hospital Charge Code	270671739
Hospital Revenue Code	278
Min. Negotiated Rate	$969.75
Max. Negotiated Rate	$3,232.50
Rate for Payer: Aetna Commercial	$1,939.50
Rate for Payer: Aetna Medicare Advantage	$1,939.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,648.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,648.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,648.58
Rate for Payer: Cigna Commercial	$3,232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.53
Rate for Payer: Qualcare PPO/HMO/WC	$969.75

BONE GRAFT INQU GRANULES 30CC

Facility

$14,940.00

Hospital Charge Code	270671740
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.00
Max. Negotiated Rate	$3,615.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.00

BONE GRAFT INQU GRANULES 30CC

Facility

$14,940.00

Hospital Charge Code	270671740
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.00
Max. Negotiated Rate	$7,470.00
Rate for Payer: Aetna Commercial	$4,482.00
Rate for Payer: Aetna Medicare Advantage	$4,482.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,809.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,809.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,809.70
Rate for Payer: Cigna Commercial	$7,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.00

BONE GRAFT KIT 10CC

Facility

$10,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270688355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$3,262.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

BONE GRAFT KIT 10CC

Facility

$10,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270688355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

BONE GRAFT KIT 8CC

Facility

$27,845.00

Service Code	HCPCS C1763
Hospital Charge Code	270652415
Hospital Revenue Code	278
Min. Negotiated Rate	$4,176.75
Max. Negotiated Rate	$6,738.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,738.49
Rate for Payer: Qualcare PPO/HMO/WC	$4,176.75

BONE GRAFT KIT 8CC

Facility

$27,845.00

Service Code	HCPCS C1763
Hospital Charge Code	270652415
Hospital Revenue Code	278
Min. Negotiated Rate	$4,176.75
Max. Negotiated Rate	$13,922.50
Rate for Payer: Aetna Commercial	$8,353.50
Rate for Payer: Aetna Medicare Advantage	$8,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,100.48
Rate for Payer: Cigna Commercial	$13,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,738.49
Rate for Payer: Qualcare PPO/HMO/WC	$4,176.75

BONE GRAFT KIT INFUSE XX SMALL

Facility

$4,775.00

Service Code	HCPCS L8699
Hospital Charge Code	270692241
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$2,387.50
Rate for Payer: Aetna Commercial	$1,432.50
Rate for Payer: Aetna Medicare Advantage	$1,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,217.62
Rate for Payer: Cigna Commercial	$2,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

BONE GRAFT KIT INFUSE XX SMALL

Facility

$4,775.00

Service Code	HCPCS L8699
Hospital Charge Code	270692241
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$1,155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

BONE GRAFT MATRIX 5X5CM 17.5CC

Facility

$15,665.00

Hospital Charge Code	270671746
Hospital Revenue Code	278
Min. Negotiated Rate	$2,349.75
Max. Negotiated Rate	$3,790.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,790.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,349.75

BONE GRAFT MATRIX 5X5CM 17.5CC

Facility

$15,665.00

Hospital Charge Code	270671746
Hospital Revenue Code	278
Min. Negotiated Rate	$2,349.75
Max. Negotiated Rate	$7,832.50
Rate for Payer: Aetna Commercial	$4,699.50
Rate for Payer: Aetna Medicare Advantage	$4,699.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,994.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,994.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,994.57
Rate for Payer: Cigna Commercial	$7,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,790.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,349.75

BONE GRAFT MATRIX 5X5CM 8.75CC

Facility

$9,395.00

Hospital Charge Code	270671745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,409.25
Max. Negotiated Rate	$4,697.50
Rate for Payer: Aetna Commercial	$2,818.50
Rate for Payer: Aetna Medicare Advantage	$2,818.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,879.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,395.72
Rate for Payer: Cigna Commercial	$4,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.25

BONE GRAFT MATRIX 5X5CM 8.75CC

Facility

$9,395.00

Hospital Charge Code	270671745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,409.25
Max. Negotiated Rate	$2,273.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,879.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.25

Know your out-of-pocket cost for care.

All Charges