Heights University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT OSSILIX FIL 10CC

Facility

$11,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270682056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.75
Max. Negotiated Rate	$5,992.50
Rate for Payer: Aetna Commercial	$3,595.50
Rate for Payer: Aetna Medicare Advantage	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,056.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,056.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,056.18
Rate for Payer: Cigna Commercial	$5,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,900.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,797.75

CEMENT PALACOS BONE 424800

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270618650
Hospital Revenue Code	278
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$163.50
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

CEMENT PALACOS BONE 424800

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270618650
Hospital Revenue Code	278
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$131.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

CEMENT PALACOS LOW VISCOSIT

Facility

$502.50

Hospital Charge Code	270660974
Hospital Revenue Code	278
Min. Negotiated Rate	$75.38
Max. Negotiated Rate	$121.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.61
Rate for Payer: Qualcare PPO/HMO/WC	$75.38

CEMENT PALACOS LOW VISCOSIT

Facility

$502.50

Hospital Charge Code	270660974
Hospital Revenue Code	278
Min. Negotiated Rate	$75.38
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna Commercial	$150.75
Rate for Payer: Aetna Medicare Advantage	$150.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.14
Rate for Payer: Cigna Commercial	$251.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.61
Rate for Payer: Qualcare PPO/HMO/WC	$75.38

CEMENT PALACOS LOW VISCOSITY W

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270660975
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

CEMENT PALACOS LOW VISCOSITY W

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270660975
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

CEMENT PALACOS R+G SINGLE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270679667
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

CEMENT PALACOS R+G SINGLE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270679667
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

CEMENT PREP KIT FEMORAL BONE

Facility

$1,032.00

Hospital Charge Code	270635406
Hospital Revenue Code	272
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Qualcare PPO/HMO/WC	$154.80

CEMENT PREP KIT FEMORAL BONE

Facility

$1,032.00

Hospital Charge Code	270635406
Hospital Revenue Code	272
Min. Negotiated Rate	$134.16
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$309.60
Rate for Payer: Aetna Medicare Advantage	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.16
Rate for Payer: Cigna Commercial	$516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.16
Rate for Payer: Oxford Commercial	$516.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.80
Rate for Payer: UnitedHealthcare Commercial	$516.00

CEMENT REFOBACIN BC R 40 GM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682312
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CEMENT REFOBACIN BC R 40 GM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682312
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CEMENT RESTRICTOR

Facility

$395.00

Service Code	HCPCS C1776
Hospital Charge Code	270691681
Hospital Revenue Code	278
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$118.50
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

CEMENT RESTRICTOR

Facility

$395.00

Service Code	HCPCS C1776
Hospital Charge Code	270691681
Hospital Revenue Code	278
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$95.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

CEMENT RESTRICTOR FEMORAL SZ 3

Facility

$597.00

Hospital Charge Code	270330690
Hospital Revenue Code	278
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$298.50
Rate for Payer: Aetna Commercial	$179.10
Rate for Payer: Aetna Medicare Advantage	$179.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.24
Rate for Payer: Cigna Commercial	$298.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.47
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

CEMENT RESTRICTOR FEMORAL SZ 3

Facility

$597.00

Hospital Charge Code	270330690
Hospital Revenue Code	278
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$144.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.47
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

CEMENT RESTRICTOR FEMORAL SZ 4

Facility

$630.00

Hospital Charge Code	270330695
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

CEMENT RESTRICTOR FEMORAL SZ 4

Facility

$630.00

Hospital Charge Code	270330695
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

CEMENT RESTRICTOR-INSERTER

Facility

$1,055.00

Hospital Charge Code	270656484
Hospital Revenue Code	271
Min. Negotiated Rate	$158.25
Max. Negotiated Rate	$158.25
Rate for Payer: Qualcare PPO/HMO/WC	$158.25

CEMENT RESTRICTOR-INSERTER

Facility

$1,055.00

Hospital Charge Code	270656484
Hospital Revenue Code	271
Min. Negotiated Rate	$137.15
Max. Negotiated Rate	$527.50
Rate for Payer: Aetna Commercial	$316.50
Rate for Payer: Aetna Medicare Advantage	$316.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.02
Rate for Payer: Cigna Commercial	$527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.15
Rate for Payer: Oxford Commercial	$527.50
Rate for Payer: Qualcare PPO/HMO/WC	$158.25
Rate for Payer: UnitedHealthcare Commercial	$527.50

CEMENT RESTRICTOR SIZE 1

Facility

$547.00

Hospital Charge Code	270332160
Hospital Revenue Code	278
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$132.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.37
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

CEMENT RESTRICTOR SIZE 1

Facility

$547.00

Hospital Charge Code	270332160
Hospital Revenue Code	278
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$273.50
Rate for Payer: Aetna Commercial	$164.10
Rate for Payer: Aetna Medicare Advantage	$164.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.49
Rate for Payer: Cigna Commercial	$273.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.37
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

CEMENT RESTRICTOR SZ3 13.25MM

Facility

$1,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270699295
Hospital Revenue Code	278
Min. Negotiated Rate	$210.75
Max. Negotiated Rate	$340.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.75

CEMENT RESTRICTOR SZ3 13.25MM

Facility

$1,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270699295
Hospital Revenue Code	278
Min. Negotiated Rate	$210.75
Max. Negotiated Rate	$702.50
Rate for Payer: Aetna Commercial	$421.50
Rate for Payer: Aetna Medicare Advantage	$421.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.27
Rate for Payer: Cigna Commercial	$702.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.75

Know your out-of-pocket cost for care.

All Charges