Heights University Hospital

All Charges

Charge

Type

Setting

Price

BONE VOID FILLER 10ML

Facility

$13,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669259
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$3,900.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

BONE VOID FILLER 10ML

Facility

$13,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270669259
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

BONE VOID FILLER 1CC

Facility

$2,626.25

Hospital Charge Code	270671238
Hospital Revenue Code	278
Min. Negotiated Rate	$393.94
Max. Negotiated Rate	$635.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.55
Rate for Payer: Qualcare PPO/HMO/WC	$393.94

BONE VOID FILLER 1CC

Facility

$2,626.25

Hospital Charge Code	270671238
Hospital Revenue Code	278
Min. Negotiated Rate	$393.94
Max. Negotiated Rate	$1,313.12
Rate for Payer: Aetna Commercial	$787.88
Rate for Payer: Aetna Medicare Advantage	$787.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.69
Rate for Payer: Cigna Commercial	$1,313.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.55
Rate for Payer: Qualcare PPO/HMO/WC	$393.94

BONE VOID FILLER 20CC

Facility

$19,868.75

Hospital Charge Code	270671232
Hospital Revenue Code	278
Min. Negotiated Rate	$2,980.31
Max. Negotiated Rate	$9,934.38
Rate for Payer: Aetna Commercial	$5,960.62
Rate for Payer: Aetna Medicare Advantage	$5,960.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,066.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,066.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,973.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,066.53
Rate for Payer: Cigna Commercial	$9,934.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,808.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,980.31

BONE VOID FILLER 20CC

Facility

$19,868.75

Hospital Charge Code	270671232
Hospital Revenue Code	278
Min. Negotiated Rate	$2,980.31
Max. Negotiated Rate	$4,808.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,973.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,808.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,980.31

BONE VOID FILLER 2CC

Facility

$3,148.75

Hospital Charge Code	270671239
Hospital Revenue Code	278
Min. Negotiated Rate	$472.31
Max. Negotiated Rate	$1,574.38
Rate for Payer: Aetna Commercial	$944.62
Rate for Payer: Aetna Medicare Advantage	$944.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$802.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$802.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$629.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$802.93
Rate for Payer: Cigna Commercial	$1,574.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.31

BONE VOID FILLER 2CC

Facility

$3,148.75

Hospital Charge Code	270671239
Hospital Revenue Code	278
Min. Negotiated Rate	$472.31
Max. Negotiated Rate	$762.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$629.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.31

BONE VOID FILLER 5CC

Facility

$6,668.75

Service Code	HCPCS C1713
Hospital Charge Code	270671240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.31
Max. Negotiated Rate	$1,613.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,613.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.31

BONE VOID FILLER 5CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701475
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

BONE VOID FILLER 5CC

Facility

$6,668.75

Service Code	HCPCS C1713
Hospital Charge Code	270671240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.31
Max. Negotiated Rate	$3,334.38
Rate for Payer: Aetna Commercial	$2,000.62
Rate for Payer: Aetna Medicare Advantage	$2,000.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,700.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,700.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,700.53
Rate for Payer: Cigna Commercial	$3,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,613.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.31

BONE VOID FILLER 5CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701475
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

BONE VOID FILLER 5CC 25X50X4

Facility

$8,332.50

Hospital Charge Code	270671237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.88
Max. Negotiated Rate	$2,016.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,666.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,016.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,249.88

BONE VOID FILLER 5CC 25X50X4

Facility

$8,332.50

Hospital Charge Code	270671237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.88
Max. Negotiated Rate	$4,166.25
Rate for Payer: Aetna Commercial	$2,499.75
Rate for Payer: Aetna Medicare Advantage	$2,499.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,124.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,124.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,666.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,124.79
Rate for Payer: Cigna Commercial	$4,166.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,016.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,249.88

BONE WAX

Facility

$23.90

Hospital Charge Code	270604717
Hospital Revenue Code	272
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.58

BONE WAX

Facility

$22.10

Hospital Charge Code	270653366
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

BONE WAX

Facility

$22.10

Hospital Charge Code	270653366
Hospital Revenue Code	272
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$6.63
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.64
Rate for Payer: Cigna Commercial	$11.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$11.05

BONE WAX

Facility

$72.00

Hospital Charge Code	270335098
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

BONE WAX

Facility

$23.90

Hospital Charge Code	270604717
Hospital Revenue Code	272
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$11.95
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna Medicare Advantage	$7.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.09
Rate for Payer: Cigna Commercial	$11.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.11
Rate for Payer: Oxford Commercial	$11.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.58
Rate for Payer: UnitedHealthcare Commercial	$11.95

BONE WAX

Facility

$72.00

Hospital Charge Code	270335098
Hospital Revenue Code	272
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$36.00

BONE WAX 2.5G NON ABSORBABLE

Facility

$46.78

Hospital Charge Code	270651257
Hospital Revenue Code	272
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$23.39
Rate for Payer: Aetna Commercial	$14.03
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.93
Rate for Payer: Cigna Commercial	$23.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.08
Rate for Payer: Oxford Commercial	$23.39
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Commercial	$23.39

BONE WAX 2.5G NON ABSORBABLE

Facility

$46.78

Hospital Charge Code	270651257
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

BOOKLETS, CRUTCHES, WALKERS &

Facility

$10.00

Hospital Charge Code	270665587
Hospital Revenue Code	270
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

BOOKLETS, CRUTCHES, WALKERS &

Facility

$10.00

Hospital Charge Code	270665586
Hospital Revenue Code	270
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

BOOKLETS, CRUTCHES, WALKERS &

Facility

$10.00

Hospital Charge Code	270665587
Hospital Revenue Code	270
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

Know your out-of-pocket cost for care.

All Charges