Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,725.90
Rate for Payer: Aetna Commercial	$1,035.54
Rate for Payer: Aetna Medicare Advantage	$1,035.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$880.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$880.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$880.21
Rate for Payer: Cigna Commercial	$1,725.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.34
Rate for Payer: Qualcare PPO/HMO/WC	$517.77

GRAFT ACELLULAR 6CMX12CM ALLO-

Facility

$3,621.60

Hospital Charge Code	270641308
Hospital Revenue Code	278
Min. Negotiated Rate	$543.24
Max. Negotiated Rate	$1,810.80
Rate for Payer: Aetna Commercial	$1,086.48
Rate for Payer: Aetna Medicare Advantage	$1,086.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$724.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.51
Rate for Payer: Cigna Commercial	$1,810.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.43
Rate for Payer: Qualcare PPO/HMO/WC	$543.24

GRAFT ACELLULAR 6CMX12CM ALLO-

Facility

$3,621.60

Hospital Charge Code	270641308
Hospital Revenue Code	278
Min. Negotiated Rate	$543.24
Max. Negotiated Rate	$876.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$724.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.43
Rate for Payer: Qualcare PPO/HMO/WC	$543.24

GRAFT ACHILLES TENDON 10MM

Facility

$13,205.00

Hospital Charge Code	270675985
Hospital Revenue Code	278
Min. Negotiated Rate	$1,980.75
Max. Negotiated Rate	$6,602.50
Rate for Payer: Aetna Commercial	$3,961.50
Rate for Payer: Aetna Medicare Advantage	$3,961.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,367.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,367.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,367.28
Rate for Payer: Cigna Commercial	$6,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,195.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,980.75

GRAFT ACHILLES TENDON 10MM

Facility

$13,205.00

Hospital Charge Code	270675985
Hospital Revenue Code	278
Min. Negotiated Rate	$1,980.75
Max. Negotiated Rate	$3,195.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,641.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,195.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,980.75

GRAFT ACUSEAL 6mm X 40cm

Facility

$6,400.00

Service Code	HCPCS C1768
Hospital Charge Code	270665692
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: Aetna Commercial	$1,920.00
Rate for Payer: Aetna Medicare Advantage	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,632.00
Rate for Payer: Cigna Commercial	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: Qualcare PPO/HMO/WC	$960.00

GRAFT ACUSEAL 6mm X 40cm

Facility

$6,400.00

Service Code	HCPCS C1768
Hospital Charge Code	270665692
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$1,548.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: Qualcare PPO/HMO/WC	$960.00

GRAFT AD 3cmX7cm XTHICK 982021

Facility

$3,945.00

Hospital Charge Code	270639960
Hospital Revenue Code	636
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,183.50
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

GRAFT AD 3cmX7cm XTHICK 982021

Facility

$3,945.00

Hospital Charge Code	270639960
Hospital Revenue Code	636
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$954.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

GRAFT ADVANCE 2 X 30MM

Facility

$12,125.00

Service Code	HCPCS C1768
Hospital Charge Code	270664249
Hospital Revenue Code	278
Min. Negotiated Rate	$1,818.75
Max. Negotiated Rate	$6,062.50
Rate for Payer: Aetna Commercial	$3,637.50
Rate for Payer: Aetna Medicare Advantage	$3,637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,091.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,091.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,091.88
Rate for Payer: Cigna Commercial	$6,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,934.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,818.75

GRAFT ADVANCE 2 X 30MM

Facility

$12,125.00

Service Code	HCPCS C1768
Hospital Charge Code	270664249
Hospital Revenue Code	278
Min. Negotiated Rate	$1,818.75
Max. Negotiated Rate	$2,934.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,934.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,818.75

GRAFT AFT MAIN BODY

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683899
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$19,738.50
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFT MAIN BODY

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683899
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX2 MAIN BODY 22 X 90MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683903
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX2 MAIN BODY 22 X 90MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683903
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$19,738.50
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX AORTIC EXT 25x25x75

Facility

$26,495.00

Hospital Charge Code	270646898
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$6,411.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AFX AORTIC EXT 25x25x75

Facility

$26,495.00

Hospital Charge Code	270646898
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$13,247.50
Rate for Payer: Aetna Commercial	$7,948.50
Rate for Payer: Aetna Medicare Advantage	$7,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,756.23
Rate for Payer: Cigna Commercial	$13,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AFX AORTIC EXT 28x75x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270647243
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$12,450.00
Rate for Payer: Aetna Commercial	$7,470.00
Rate for Payer: Aetna Medicare Advantage	$7,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,349.50
Rate for Payer: Cigna Commercial	$12,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 28x75x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270647243
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$6,025.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 28x95x20

Facility

$26,495.00

Hospital Charge Code	270664504
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$13,247.50
Rate for Payer: Aetna Commercial	$7,948.50
Rate for Payer: Aetna Medicare Advantage	$7,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,756.23
Rate for Payer: Cigna Commercial	$13,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AFX AORTIC EXT 28x95x20

Facility

$26,495.00

Hospital Charge Code	270664504
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$6,411.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AFX AORTIC EXT 34x100x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270646484
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$6,025.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 34x100x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270646484
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$12,450.00
Rate for Payer: Aetna Commercial	$7,470.00
Rate for Payer: Aetna Medicare Advantage	$7,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,349.50
Rate for Payer: Cigna Commercial	$12,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 34x34x20

Facility

$24,900.00

Hospital Charge Code	270673846
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$12,450.00
Rate for Payer: Aetna Commercial	$7,470.00
Rate for Payer: Aetna Medicare Advantage	$7,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,349.50
Rate for Payer: Cigna Commercial	$12,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 34x34x20

Facility

$24,900.00

Hospital Charge Code	270673846
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$6,025.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

Know your out-of-pocket cost for care.

All Charges