Heights University Hospital

All Charges

Charge

Type

Setting

Price

GPS TAP CANNULATED 5.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698380
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$1,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GPS TAP CANNULATED 5.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698380
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$3,095.00
Rate for Payer: Cigna Commercial	$3,095.00
Rate for Payer: Aetna Commercial	$1,857.00
Rate for Payer: Aetna Medicare Advantage	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,578.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GPS TAP CANNULATED TAP 4.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698382
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$1,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GPS TAP CANNULATED TAP 4.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698382
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$3,095.00
Rate for Payer: Aetna Commercial	$1,857.00
Rate for Payer: Aetna Medicare Advantage	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,578.45
Rate for Payer: Cigna Commercial	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GRADUATED G PIN SLEEVE

Facility

$1,025.00

Hospital Charge Code	270691449
Hospital Revenue Code	272
Min. Negotiated Rate	$133.25
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$307.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.25
Rate for Payer: Oxford Commercial	$512.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$512.50

GRADUATED G PIN SLEEVE

Facility

$1,025.00

Hospital Charge Code	270691449
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

GRADUATE TRIANGULAR DISP 32oz

Facility

$0.82

Hospital Charge Code	270649520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna Commercial	$0.25
Rate for Payer: Aetna Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.21
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.11
Rate for Payer: Oxford Commercial	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.12
Rate for Payer: UnitedHealthcare Commercial	$0.41

GRADUATE TRIANGULAR DISP 32oz

Facility

$0.82

Hospital Charge Code	270649520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.12

GRAFIX PRIME/SQ CM

Facility

$684.00

Service Code	HCPCS Q4133
Hospital Charge Code	9808333
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$165.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFIX PRIME/SQ CM

Facility

$684.00

Service Code	HCPCS Q4133
Hospital Charge Code	9808333
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$205.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.42
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFIX PRIME/SQ CM JW

Facility

$684.00

Service Code	HCPCS Q4133JW
Hospital Charge Code	9808333W
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$205.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.42
Rate for Payer: Cigna Commercial	$342.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFIX PRIME/SQ CM JW

Facility

$684.00

Service Code	HCPCS Q4133JW
Hospital Charge Code	9808333W
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$165.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFT 10MM X 80 CM X 70 CM RIN

Facility

$6,845.00

Service Code	HCPCS L8670
Hospital Charge Code	270690161
Hospital Revenue Code	278
Min. Negotiated Rate	$408.89
Max. Negotiated Rate	$2,053.50
Rate for Payer: Aetna Commercial	$2,053.50
Rate for Payer: Aetna Medicare Advantage	$2,053.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,745.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,745.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,745.47
Rate for Payer: Cigna Commercial	$681.49
Rate for Payer: Cigna Medicare Advantage	$408.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,656.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.75

GRAFT 10MM X 80 CM X 70 CM RIN

Facility

$6,845.00

Service Code	HCPCS L8670
Hospital Charge Code	270690161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,026.75
Max. Negotiated Rate	$1,656.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,656.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.75

GRAFT 12 MM X 30 CM RING

Facility

$5,395.00

Service Code	HCPCS L8670
Hospital Charge Code	270690160
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$1,305.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: Qualcare PPO/HMO/WC	$809.25

GRAFT 12 MM X 30 CM RING

Facility

$5,395.00

Service Code	HCPCS L8670
Hospital Charge Code	270690160
Hospital Revenue Code	278
Min. Negotiated Rate	$408.89
Max. Negotiated Rate	$1,618.50
Rate for Payer: Aetna Commercial	$1,618.50
Rate for Payer: Aetna Medicare Advantage	$1,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,375.72
Rate for Payer: Cigna Commercial	$681.49
Rate for Payer: Cigna Medicare Advantage	$408.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: Qualcare PPO/HMO/WC	$809.25

GRAFT 4X8CM

Facility

$15,640.00

Service Code	HCPCS Q4248
Hospital Charge Code	270694137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.00
Max. Negotiated Rate	$3,784.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00

GRAFT 4X8CM

Facility

$15,640.00

Service Code	HCPCS Q4248
Hospital Charge Code	270694137
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,692.00
Rate for Payer: Aetna Commercial	$4,692.00
Rate for Payer: Aetna Medicare Advantage	$4,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.20
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00

GRAFT 6MMX30CM FLIXENE

Facility

$5,499.65

Service Code	HCPCS C1768
Hospital Charge Code	270689835
Hospital Revenue Code	278
Min. Negotiated Rate	$824.95
Max. Negotiated Rate	$2,749.82
Rate for Payer: Aetna Commercial	$1,649.89
Rate for Payer: Aetna Medicare Advantage	$1,649.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,099.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.41
Rate for Payer: Cigna Commercial	$2,749.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,330.92
Rate for Payer: Qualcare PPO/HMO/WC	$824.95

GRAFT 6MMX30CM FLIXENE

Facility

$5,499.65

Service Code	HCPCS C1768
Hospital Charge Code	270689835
Hospital Revenue Code	278
Min. Negotiated Rate	$824.95
Max. Negotiated Rate	$1,330.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,099.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,330.92
Rate for Payer: Qualcare PPO/HMO/WC	$824.95

GRAFT 6MMX38CM

Facility

$6,095.00

Hospital Charge Code	270686035
Hospital Revenue Code	278
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$1,828.50
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

GRAFT 6MMX38CM

Facility

$6,095.00

Hospital Charge Code	270686035
Hospital Revenue Code	278
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$1,474.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

GRAFT 7MM X 50CM 40CM RINGS

Facility

$13,635.00

Service Code	HCPCS L8699
Hospital Charge Code	270700852
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

GRAFT 7MM X 50CM 40CM RINGS

Facility

$13,635.00

Service Code	HCPCS L8699
Hospital Charge Code	270700852
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$6,817.50
Rate for Payer: Aetna Commercial	$4,090.50
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$6,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

GRAFT ACELL ALLOD 6X11C 101010

Facility

$3,451.80

Hospital Charge Code	270642027
Hospital Revenue Code	636
Min. Negotiated Rate	$517.77
Max. Negotiated Rate	$835.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.34
Rate for Payer: Qualcare PPO/HMO/WC	$517.77

Know your out-of-pocket cost for care.

All Charges