Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270665612
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270665612
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270667712
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845O
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845O
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x60mm

Facility

$57,900.00

Hospital Charge Code	270646485
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x60mm

Facility

$57,900.00

Hospital Charge Code	270646485
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x70

Facility

$65,795.00

Hospital Charge Code	270677830
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 AFX MAIN BODY 28x70

Facility

$65,795.00

Hospital Charge Code	270677830
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 MAIN BODY 28x70mm

Facility

$57,900.00

Hospital Charge Code	270646239
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x70mm

Facility

$57,900.00

Hospital Charge Code	270646239
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X70MM

Facility

$57,900.00

Hospital Charge Code	270667713
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X70MM

Facility

$57,900.00

Hospital Charge Code	270667713
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X90MM

Facility

$57,900.00

Hospital Charge Code	270666861
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X90MM

Facility

$57,900.00

Hospital Charge Code	270666861
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AG PRIMATRIX 8x12cm

Facility

$15,695.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673606
Hospital Revenue Code	278
Min. Negotiated Rate	$2,354.25
Max. Negotiated Rate	$3,798.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,798.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,354.25

GRAFT AG PRIMATRIX 8x12cm

Facility

$15,695.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673606
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,708.50
Rate for Payer: Aetna Commercial	$4,708.50
Rate for Payer: Aetna Medicare Advantage	$4,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,002.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,002.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,002.22
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,798.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,354.25

GRAFT ALDERM NON-MH 200 201010

Facility

$41.20

Service Code	HCPCS Q4116
Hospital Charge Code	270633030
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$12.36
Rate for Payer: Aetna Medicare Advantage	$12.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.51
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.18

GRAFT ALDERM NON-MH 200 201010

Facility

$41.20

Service Code	HCPCS Q4116
Hospital Charge Code	270633030
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$9.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.18

GRAFT ALLOAID PIP SZ 2.5X16MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270698494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

GRAFT ALLOAID PIP SZ 2.5X16MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270698494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,362.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

GRAFT ALLODERM2cm x 4cm 102012

Facility

$2,320.00

Hospital Charge Code	270641307
Hospital Revenue Code	636
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$1,160.00
Rate for Payer: Aetna Commercial	$696.00
Rate for Payer: Aetna Medicare Advantage	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.60
Rate for Payer: Cigna Commercial	$1,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

GRAFT ALLODERM2cm x 4cm 102012

Facility

$2,320.00

Hospital Charge Code	270641307
Hospital Revenue Code	636
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$561.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

Know your out-of-pocket cost for care.

All Charges