Heights University Hospital

All Charges

Charge

Type

Setting

Price

BONE GRAFT PASTE MIX PLUS 10CC

Facility

$9,755.00

Hospital Charge Code	270671744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.25
Max. Negotiated Rate	$4,877.50
Rate for Payer: Aetna Commercial	$2,926.50
Rate for Payer: Aetna Medicare Advantage	$2,926.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,487.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,487.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,951.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,487.53
Rate for Payer: Cigna Commercial	$4,877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,360.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,463.25

BONE GRAFT PASTE MIX PLUS 10CC

Facility

$9,755.00

Hospital Charge Code	270671744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.25
Max. Negotiated Rate	$2,360.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,951.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,360.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,463.25

BONE GRAFT PASTE MIX PLUS 1.25

Facility

$2,615.00

Hospital Charge Code	270671741
Hospital Revenue Code	278
Min. Negotiated Rate	$392.25
Max. Negotiated Rate	$1,307.50
Rate for Payer: Aetna Commercial	$784.50
Rate for Payer: Aetna Medicare Advantage	$784.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.83
Rate for Payer: Cigna Commercial	$1,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.83
Rate for Payer: Qualcare PPO/HMO/WC	$392.25

BONE GRAFT PASTE MIX PLUS 1.25

Facility

$2,615.00

Hospital Charge Code	270671741
Hospital Revenue Code	278
Min. Negotiated Rate	$392.25
Max. Negotiated Rate	$632.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.83
Rate for Payer: Qualcare PPO/HMO/WC	$392.25

BONE GRAFT PASTE MIX PLUS 2.5

Facility

$3,615.00

Hospital Charge Code	270671742
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$1,807.50
Rate for Payer: Aetna Commercial	$1,084.50
Rate for Payer: Aetna Medicare Advantage	$1,084.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.83
Rate for Payer: Cigna Commercial	$1,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: Qualcare PPO/HMO/WC	$542.25

BONE GRAFT PASTE MIX PLUS 2.5

Facility

$3,615.00

Hospital Charge Code	270671742
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$874.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: Qualcare PPO/HMO/WC	$542.25

BONE GRAFT PASTE MIX PLUS 5CC

Facility

$5,845.00

Hospital Charge Code	270671743
Hospital Revenue Code	278
Min. Negotiated Rate	$876.75
Max. Negotiated Rate	$2,922.50
Rate for Payer: Aetna Commercial	$1,753.50
Rate for Payer: Aetna Medicare Advantage	$1,753.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,490.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,490.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,490.47
Rate for Payer: Cigna Commercial	$2,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.49
Rate for Payer: Qualcare PPO/HMO/WC	$876.75

BONE GRAFT PASTE MIX PLUS 5CC

Facility

$5,845.00

Hospital Charge Code	270671743
Hospital Revenue Code	278
Min. Negotiated Rate	$876.75
Max. Negotiated Rate	$1,414.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.49
Rate for Payer: Qualcare PPO/HMO/WC	$876.75

BONE GRAFT STRIP 12x12x12MM

Facility

$2,700.00

Hospital Charge Code	270671734
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$653.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.40
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BONE GRAFT STRIP 12x12x12MM

Facility

$2,700.00

Hospital Charge Code	270671734
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.40
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BONE GRAFT STRIP 14x14x14MM

Facility

$3,600.00

Hospital Charge Code	270671735
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,080.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

BONE GRAFT STRIP 14x14x14MM

Facility

$3,600.00

Hospital Charge Code	270671735
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

BONE GRAFT STRIP 26x19x7MM

Facility

$6,300.00

Hospital Charge Code	270671727
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

BONE GRAFT STRIP 26x19x7MM

Facility

$6,300.00

Hospital Charge Code	270671727
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$1,890.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

BONE GRAFT STRIP 50x10x7MM

Facility

$6,300.00

Hospital Charge Code	270671726
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$1,890.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

BONE GRAFT STRIP 50x10x7MM

Facility

$6,300.00

Hospital Charge Code	270671726
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

BONE GRAFT STRIP 50x15x7MM

Facility

$9,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270671728
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.25
Max. Negotiated Rate	$4,667.50
Rate for Payer: Aetna Commercial	$2,800.50
Rate for Payer: Aetna Medicare Advantage	$2,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,380.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,380.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,380.43
Rate for Payer: Cigna Commercial	$4,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,259.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,400.25

BONE GRAFT STRIP 50x15x7MM

Facility

$9,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270671728
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.25
Max. Negotiated Rate	$2,259.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,867.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,259.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,400.25

BONE GRAFT SUB PRO OSTEN 2RG15

Facility

$5,232.85

Hospital Charge Code	270632401
Hospital Revenue Code	272
Min. Negotiated Rate	$784.93
Max. Negotiated Rate	$784.93
Rate for Payer: Qualcare PPO/HMO/WC	$784.93

BONE GRAFT SUB PRO OSTEN 2RG15

Facility

$5,232.85

Hospital Charge Code	270632401
Hospital Revenue Code	272
Min. Negotiated Rate	$680.27
Max. Negotiated Rate	$2,616.43
Rate for Payer: Aetna Commercial	$1,569.86
Rate for Payer: Aetna Medicare Advantage	$1,569.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,334.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,334.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,334.38
Rate for Payer: Cigna Commercial	$2,616.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.27
Rate for Payer: Oxford Commercial	$2,616.43
Rate for Payer: Qualcare PPO/HMO/WC	$784.93
Rate for Payer: UnitedHealthcare Commercial	$2,616.43

BONE GRFT,MAJ/LG

Facility

$30,595.00

Service Code	HCPCS 20902
Hospital Charge Code	16000795
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

BONE GRFT,MAJ/LG

Facility

$30,595.00

Service Code	HCPCS 20902
Hospital Charge Code	16000795
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$9,178.50
Rate for Payer: Aetna Medicare Advantage	$9,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,801.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,801.73
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	$7,801.73
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,977.35
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

BONE GRFT,MINOR/SM

Facility

$30,595.00

Service Code	HCPCS 20900
Hospital Charge Code	16000336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$9,178.50
Rate for Payer: Aetna Medicare Advantage	$9,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,801.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,801.73
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	$7,801.73
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,977.35
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

BONE GRFT,MINOR/SM

Facility

$30,595.00

Service Code	HCPCS 20900
Hospital Charge Code	16000336
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

BONE GUIDE GLENOID LT

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270699507
Hospital Revenue Code	272
Min. Negotiated Rate	$741.00
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.00
Rate for Payer: Oxford Commercial	$2,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,850.00

Know your out-of-pocket cost for care.

All Charges