Heights University Hospital

All Charges

Charge

Type

Setting

Price

BONE CEMENT SIMPLEX FULL DOSE

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270672934
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BONE CEMENT SIMPLEX FULL DOSE

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270651646
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HALF DOSE

Facility

$250.00

Hospital Charge Code	270673756
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

BONE CEMENT SIMPLEX HALF DOSE

Facility

$250.00

Hospital Charge Code	270673756
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

BONE CEMENT SIMPLEX HALF DOSE

Facility

$249.50

Hospital Charge Code	270673759
Hospital Revenue Code	278
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$60.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.42

BONE CEMENT SIMPLEX HALF DOSE

Facility

$249.50

Hospital Charge Code	270673759
Hospital Revenue Code	278
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$124.75
Rate for Payer: Aetna Commercial	$74.85
Rate for Payer: Aetna Medicare Advantage	$74.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.62
Rate for Payer: Cigna Commercial	$124.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.42

BONE CEMENT SIMPLEX HV

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270669204
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV

Facility

$355.00

Hospital Charge Code	270673762
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV

Facility

$355.00

Hospital Charge Code	270673762
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270669204
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.77

Hospital Charge Code	270673387
Hospital Revenue Code	278
Min. Negotiated Rate	$151.02
Max. Negotiated Rate	$243.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.64
Rate for Payer: Qualcare PPO/HMO/WC	$151.02

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.77

Hospital Charge Code	270673387
Hospital Revenue Code	278
Min. Negotiated Rate	$151.02
Max. Negotiated Rate	$503.38
Rate for Payer: Aetna Commercial	$302.03
Rate for Payer: Aetna Medicare Advantage	$302.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.73
Rate for Payer: Cigna Commercial	$503.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.64
Rate for Payer: Qualcare PPO/HMO/WC	$151.02

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.75

Service Code	HCPCS C1713
Hospital Charge Code	270669205
Hospital Revenue Code	278
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$503.38
Rate for Payer: Aetna Commercial	$302.02
Rate for Payer: Aetna Medicare Advantage	$302.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.72
Rate for Payer: Cigna Commercial	$503.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.63
Rate for Payer: Qualcare PPO/HMO/WC	$151.01

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.75

Service Code	HCPCS C1713
Hospital Charge Code	270669205
Hospital Revenue Code	278
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$243.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.63
Rate for Payer: Qualcare PPO/HMO/WC	$151.01

BONE CEMENT TOB FULL DOSE

Facility

$1,490.00

Hospital Charge Code	270673763
Hospital Revenue Code	278
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

BONE CEMENT TOB FULL DOSE

Facility

$1,490.00

Hospital Charge Code	270673763
Hospital Revenue Code	278
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$745.00
Rate for Payer: Aetna Commercial	$447.00
Rate for Payer: Aetna Medicare Advantage	$447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.95
Rate for Payer: Cigna Commercial	$745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

BONE CEMENT TOB FULL DOSE

Facility

$1,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270660302
Hospital Revenue Code	278
Min. Negotiated Rate	$234.75
Max. Negotiated Rate	$782.50
Rate for Payer: Aetna Commercial	$469.50
Rate for Payer: Aetna Medicare Advantage	$469.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$313.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.07
Rate for Payer: Cigna Commercial	$782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.73
Rate for Payer: Qualcare PPO/HMO/WC	$234.75

BONE CEMENT TOB FULL DOSE

Facility

$1,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270660302
Hospital Revenue Code	278
Min. Negotiated Rate	$234.75
Max. Negotiated Rate	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$313.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.73
Rate for Payer: Qualcare PPO/HMO/WC	$234.75

BONE CERAMENT BONE FILLER 5CC

Facility

$9,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270651533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$4,540.00
Rate for Payer: Aetna Commercial	$2,724.00
Rate for Payer: Aetna Medicare Advantage	$2,724.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,315.40
Rate for Payer: Cigna Commercial	$4,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

BONE CERAMENT BONE FILLER 5CC

Facility

$9,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270651533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$2,197.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

BONE CHIP CANCELLOUS,1-8MM

Facility

$1,221.50

Service Code	HCPCS C1762
Hospital Charge Code	270659902
Hospital Revenue Code	278
Min. Negotiated Rate	$183.22
Max. Negotiated Rate	$295.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.60
Rate for Payer: Qualcare PPO/HMO/WC	$183.22

BONE CHIP CANCELLOUS,1-8MM

Facility

$1,221.50

Service Code	HCPCS C1762
Hospital Charge Code	270659902
Hospital Revenue Code	278
Min. Negotiated Rate	$183.22
Max. Negotiated Rate	$610.75
Rate for Payer: Aetna Commercial	$366.45
Rate for Payer: Aetna Medicare Advantage	$366.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.48
Rate for Payer: Cigna Commercial	$610.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.60
Rate for Payer: Qualcare PPO/HMO/WC	$183.22

BONE CHIPS CANCELLOUS 30CC

Facility

$2,130.00

Service Code	HCPCS C1713
Hospital Charge Code	270673109
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$1,065.00
Rate for Payer: Aetna Commercial	$639.00
Rate for Payer: Aetna Medicare Advantage	$639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.15
Rate for Payer: Cigna Commercial	$1,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.46
Rate for Payer: Qualcare PPO/HMO/WC	$319.50

BONE CHIPS CANCELLOUS 30CC

Facility

$2,130.00

Service Code	HCPCS C1713
Hospital Charge Code	270673109
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$515.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.46
Rate for Payer: Qualcare PPO/HMO/WC	$319.50

BONE CHIPS CANCELLOUS 30CC 4MM

Facility

$2,800.00

Hospital Charge Code	270673970
Hospital Revenue Code	272
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$1,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,400.00

Know your out-of-pocket cost for care.

All Charges