Heights University Hospital

All Charges

Charge

Type

Setting

Price

FILIFORM ST TIP 12.5 4F 021904

Facility

$184.60

Hospital Charge Code	270619885
Hospital Revenue Code	272
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$92.30
Rate for Payer: Aetna Commercial	$55.38
Rate for Payer: Aetna Medicare Advantage	$55.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.07
Rate for Payer: Cigna Commercial	$92.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$92.30
Rate for Payer: Qualcare PPO/HMO/WC	$27.69
Rate for Payer: UnitedHealthcare Commercial	$92.30

FILIFORM ST TIP 12.5 4F 021904

Facility

$184.60

Hospital Charge Code	270619885
Hospital Revenue Code	272
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$27.69
Rate for Payer: Qualcare PPO/HMO/WC	$27.69

FILIFOR STR TIP 18 3FR 021803

Facility

$219.40

Hospital Charge Code	270613112
Hospital Revenue Code	272
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$32.91
Rate for Payer: Qualcare PPO/HMO/WC	$32.91

FILIFOR STR TIP 18 3FR 021803

Facility

$219.40

Hospital Charge Code	270613112
Hospital Revenue Code	272
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$109.70
Rate for Payer: Aetna Commercial	$65.82
Rate for Payer: Aetna Medicare Advantage	$65.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.95
Rate for Payer: Cigna Commercial	$109.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.52
Rate for Payer: Oxford Commercial	$109.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.91
Rate for Payer: UnitedHealthcare Commercial	$109.70

FILIF STR TIP 12.5 6FR 021906

Facility

$186.00

Hospital Charge Code	270619886
Hospital Revenue Code	272
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.18
Rate for Payer: Oxford Commercial	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$93.00

FILIF STR TIP 12.5 6FR 021906

Facility

$186.00

Hospital Charge Code	270619886
Hospital Revenue Code	272
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

FILL BONE VOID 10c THER0101010

Facility

$2,504.85

Hospital Charge Code	270635016
Hospital Revenue Code	272
Min. Negotiated Rate	$375.73
Max. Negotiated Rate	$375.73
Rate for Payer: Qualcare PPO/HMO/WC	$375.73

FILL BONE VOID 10c THER0101010

Facility

$2,504.85

Hospital Charge Code	270635016
Hospital Revenue Code	272
Min. Negotiated Rate	$325.63
Max. Negotiated Rate	$1,252.42
Rate for Payer: Aetna Commercial	$751.46
Rate for Payer: Aetna Medicare Advantage	$751.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$638.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$638.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$638.74
Rate for Payer: Cigna Commercial	$1,252.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.63
Rate for Payer: Oxford Commercial	$1,252.42
Rate for Payer: Qualcare PPO/HMO/WC	$375.73
Rate for Payer: UnitedHealthcare Commercial	$1,252.42

FILL BONE VOID 20c THER0101020

Facility

$3,918.45

Hospital Charge Code	270635017
Hospital Revenue Code	272
Min. Negotiated Rate	$509.40
Max. Negotiated Rate	$1,959.22
Rate for Payer: Aetna Commercial	$1,175.54
Rate for Payer: Aetna Medicare Advantage	$1,175.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$999.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$999.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$999.20
Rate for Payer: Cigna Commercial	$1,959.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.40
Rate for Payer: Oxford Commercial	$1,959.22
Rate for Payer: Qualcare PPO/HMO/WC	$587.77
Rate for Payer: UnitedHealthcare Commercial	$1,959.22

FILL BONE VOID 20c THER0101020

Facility

$3,918.45

Hospital Charge Code	270635017
Hospital Revenue Code	272
Min. Negotiated Rate	$587.77
Max. Negotiated Rate	$587.77
Rate for Payer: Qualcare PPO/HMO/WC	$587.77

FILLER KEY

Facility

$560.00

Hospital Charge Code	270657136
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

FILLER KEY

Facility

$560.00

Hospital Charge Code	270657136
Hospital Revenue Code	272
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$168.00
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Oxford Commercial	$280.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Commercial	$280.00

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$3,465.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$3,465.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER VTS BONE CANC 200502

Facility

$6,222.45

Hospital Charge Code	270628653
Hospital Revenue Code	272
Min. Negotiated Rate	$933.37
Max. Negotiated Rate	$933.37
Rate for Payer: Qualcare PPO/HMO/WC	$933.37

FILLER VTS BONE CANC 200502

Facility

$6,222.45

Hospital Charge Code	270628653
Hospital Revenue Code	272
Min. Negotiated Rate	$808.92
Max. Negotiated Rate	$3,111.22
Rate for Payer: Aetna Commercial	$1,866.73
Rate for Payer: Aetna Medicare Advantage	$1,866.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.72
Rate for Payer: Cigna Commercial	$3,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$808.92
Rate for Payer: Oxford Commercial	$3,111.22
Rate for Payer: Qualcare PPO/HMO/WC	$933.37
Rate for Payer: UnitedHealthcare Commercial	$3,111.22

FILL POLY KIT OPRIME PMA, 14ML

Facility

$3,750.00

Hospital Charge Code	270679785
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$1,875.00

FILL POLY KIT OPRIME PMA, 14ML

Facility

$3,750.00

Hospital Charge Code	270679785
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLYMER

Facility

$3,750.00

Hospital Charge Code	270683413
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLYMER

Facility

$3,750.00

Hospital Charge Code	270683413
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLYMER KIT

Facility

$3,750.00

Hospital Charge Code	270678257
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$1,875.00

FILL POLYMER KIT

Facility

$3,750.00

Hospital Charge Code	270678257
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILM CURIX ORTHO HTG 24X24

Facility

$116.75

Hospital Charge Code	270654382
Hospital Revenue Code	272
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$58.38
Rate for Payer: Aetna Commercial	$35.02
Rate for Payer: Aetna Medicare Advantage	$35.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.77
Rate for Payer: Cigna Commercial	$58.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.18
Rate for Payer: Oxford Commercial	$58.38
Rate for Payer: Qualcare PPO/HMO/WC	$17.51
Rate for Payer: UnitedHealthcare Commercial	$58.38

Know your out-of-pocket cost for care.

All Charges