Heights University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326O
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$324.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$324.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$671.00
Rate for Payer: Aetna Commercial	$402.60
Rate for Payer: Aetna Medicare Advantage	$402.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.21
Rate for Payer: Cigna Commercial	$671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326O
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$671.00
Rate for Payer: Aetna Commercial	$402.60
Rate for Payer: Aetna Medicare Advantage	$402.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.21
Rate for Payer: Cigna Commercial	$671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326S
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$671.00
Rate for Payer: Aetna Commercial	$402.60
Rate for Payer: Aetna Medicare Advantage	$402.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.21
Rate for Payer: Cigna Commercial	$671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326S
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$324.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE COBALT40/20 W/GENT

Facility

$2,200.00

Hospital Charge Code	270643861
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Aetna Commercial	$660.00
Rate for Payer: Aetna Medicare Advantage	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.00
Rate for Payer: Cigna Commercial	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: Qualcare PPO/HMO/WC	$330.00

CEMENT BONE COBALT40/20 W/GENT

Facility

$2,200.00

Hospital Charge Code	270643861
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: Qualcare PPO/HMO/WC	$330.00

CEMENT BONE COBALT G-HV

Facility

$3,810.00

Service Code	HCPCS C1713
Hospital Charge Code	270692264
Hospital Revenue Code	278
Min. Negotiated Rate	$571.50
Max. Negotiated Rate	$922.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$762.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$922.02
Rate for Payer: Qualcare PPO/HMO/WC	$571.50

CEMENT BONE COBALT G-HV

Facility

$3,810.00

Service Code	HCPCS C1713
Hospital Charge Code	270692264
Hospital Revenue Code	278
Min. Negotiated Rate	$571.50
Max. Negotiated Rate	$1,905.00
Rate for Payer: Aetna Commercial	$1,143.00
Rate for Payer: Aetna Medicare Advantage	$1,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$971.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$971.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$762.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$971.55
Rate for Payer: Cigna Commercial	$1,905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$922.02
Rate for Payer: Qualcare PPO/HMO/WC	$571.50

CEMENT BONE COBALT HV

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	270642312
Hospital Revenue Code	278
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$237.00
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.18
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

CEMENT BONE COBALT HV

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	270642312
Hospital Revenue Code	278
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$191.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.18
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

CEMENT BONE COBALT HV W/GENT

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Charge Code	270645007
Hospital Revenue Code	278
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$915.00
Rate for Payer: Aetna Commercial	$549.00
Rate for Payer: Aetna Medicare Advantage	$549.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$466.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$466.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$366.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$466.65
Rate for Payer: Cigna Commercial	$915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.86
Rate for Payer: Qualcare PPO/HMO/WC	$274.50

CEMENT BONE COBALT HV W/GENT

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Charge Code	270645007
Hospital Revenue Code	278
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$442.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$366.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.86
Rate for Payer: Qualcare PPO/HMO/WC	$274.50

CEMENT BONE CONFLOW

Facility

$414.45

Service Code	HCPCS C1713
Hospital Charge Code	270695534
Hospital Revenue Code	278
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$100.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.30
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

CEMENT BONE CONFLOW

Facility

$414.45

Service Code	HCPCS C1713
Hospital Charge Code	270695534
Hospital Revenue Code	278
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.30
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

CEMENT BONE DOUGH *****

Facility

$140.00

Hospital Charge Code	1601657
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$70.00

CEMENT BONE DOUGH *****

Facility

$140.00

Hospital Charge Code	1601657
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

CEMENT BONE DOUGH REGULAR

Facility

$653.00

Hospital Charge Code	270335159
Hospital Revenue Code	278
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$326.50
Rate for Payer: Aetna Commercial	$195.90
Rate for Payer: Aetna Medicare Advantage	$195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.51
Rate for Payer: Cigna Commercial	$326.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.03
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

CEMENT BONE DOUGH REGULAR

Facility

$653.00

Hospital Charge Code	270335159
Hospital Revenue Code	278
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$158.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.03
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

CEMENT BONE HYDROSET XT 10CC

Facility

$25,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696729
Hospital Revenue Code	278
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,171.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00

CEMENT BONE HYDROSET XT 10CC

Facility

$25,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696729
Hospital Revenue Code	278
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$12,750.00
Rate for Payer: Aetna Commercial	$7,650.00
Rate for Payer: Aetna Medicare Advantage	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,502.50
Rate for Payer: Cigna Commercial	$12,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,171.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00

CEMENT BONE LVC ******

Facility

$204.00

Hospital Charge Code	1601665
Hospital Revenue Code	272
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

CEMENT BONE LVC ******

Facility

$204.00

Hospital Charge Code	1601665
Hospital Revenue Code	272
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$102.00

CEMENT BONE MIMIX 10 GRAM

Facility

$9,125.00

Hospital Charge Code	270662163
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$2,208.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

Know your out-of-pocket cost for care.

All Charges