Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ALLOSYNC DBM PUTTY 1CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690969
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

GRAFT ALLOSYNE 10 CC PURE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270688461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFT ALLOSYNE 10 CC PURE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270688461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFTALTAPOREBNMATRIX15.80ML

Facility

$17,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270692787
Hospital Revenue Code	278
Min. Negotiated Rate	$2,562.00
Max. Negotiated Rate	$4,133.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,133.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,562.00

GRAFTALTAPOREBNMATRIX15.80ML

Facility

$17,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270692787
Hospital Revenue Code	278
Min. Negotiated Rate	$2,562.00
Max. Negotiated Rate	$8,540.00
Rate for Payer: Aetna Commercial	$5,124.00
Rate for Payer: Aetna Medicare Advantage	$5,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,355.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,355.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,355.40
Rate for Payer: Cigna Commercial	$8,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,133.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,562.00

GRAFT ALTAPORE BN MATRIX 2.6ML

Facility

$4,441.90

Service Code	HCPCS C1713
Hospital Charge Code	270698820
Hospital Revenue Code	278
Min. Negotiated Rate	$666.28
Max. Negotiated Rate	$1,074.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.94
Rate for Payer: Qualcare PPO/HMO/WC	$666.28

GRAFT ALTAPORE BN MATRIX 2.6ML

Facility

$4,441.90

Service Code	HCPCS C1713
Hospital Charge Code	270698820
Hospital Revenue Code	278
Min. Negotiated Rate	$666.28
Max. Negotiated Rate	$2,220.95
Rate for Payer: Aetna Commercial	$1,332.57
Rate for Payer: Aetna Medicare Advantage	$1,332.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.68
Rate for Payer: Cigna Commercial	$2,220.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.94
Rate for Payer: Qualcare PPO/HMO/WC	$666.28

GRAFT ALTAPORE BN MATRIX 8ML

Facility

$9,179.90

Service Code	HCPCS C1713
Hospital Charge Code	270698821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.98
Max. Negotiated Rate	$2,221.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,221.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.98

GRAFT ALTAPORE BN MATRIX 8ML

Facility

$9,179.90

Service Code	HCPCS C1713
Hospital Charge Code	270698821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.98
Max. Negotiated Rate	$4,589.95
Rate for Payer: Aetna Commercial	$2,753.97
Rate for Payer: Aetna Medicare Advantage	$2,753.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,340.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,340.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,340.87
Rate for Payer: Cigna Commercial	$4,589.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,221.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.98

GRAFT ALTO ABD STENT 26 MM

Facility

$74,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270690553
Hospital Revenue Code	278
Min. Negotiated Rate	$11,137.50
Max. Negotiated Rate	$17,968.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,968.50
Rate for Payer: Qualcare PPO/HMO/WC	$11,137.50

GRAFT ALTO ABD STENT 26 MM

Facility

$74,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270690553
Hospital Revenue Code	278
Min. Negotiated Rate	$11,137.50
Max. Negotiated Rate	$37,125.00
Rate for Payer: Aetna Commercial	$22,275.00
Rate for Payer: Aetna Medicare Advantage	$22,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,933.75
Rate for Payer: Cigna Commercial	$37,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,968.50
Rate for Payer: Qualcare PPO/HMO/WC	$11,137.50

GRAFT AMBIO 52 X 3CM

Facility

$3,375.00

Service Code	HCPCS C1762
Hospital Charge Code	270653917
Hospital Revenue Code	810
Min. Negotiated Rate	$438.75
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,012.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.75
Rate for Payer: Oxford Commercial	$1,687.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Commercial	$1,687.50

GRAFT AMBIO 52 X 3CM

Facility

$3,375.00

Service Code	HCPCS C1762
Hospital Charge Code	270653917
Hospital Revenue Code	810
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GRAFT AMINO EXCEL 15 MM

Facility

$1,050.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684014
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

GRAFT AMINO EXCEL 15 MM

Facility

$1,050.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684014
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

GRAFT AMINO MAX 4 X 8 CM

Facility

$15,705.00

Service Code	HCPCS Q4100
Hospital Charge Code	270686265
Hospital Revenue Code	636
Min. Negotiated Rate	$2,355.75
Max. Negotiated Rate	$3,800.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,800.61
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.75

GRAFT AMINO MAX 4 X 8 CM

Facility

$15,705.00

Service Code	HCPCS Q4100
Hospital Charge Code	270686265
Hospital Revenue Code	636
Min. Negotiated Rate	$2,355.75
Max. Negotiated Rate	$7,852.50
Rate for Payer: Aetna Commercial	$4,711.50
Rate for Payer: Aetna Medicare Advantage	$4,711.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,004.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,004.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,004.78
Rate for Payer: Cigna Commercial	$7,852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,800.61
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.75

GRAFT AMNIO EXCEL 10CMX10CM

Facility

$18,480.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684035
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$5,544.00
Rate for Payer: Aetna Commercial	$5,544.00
Rate for Payer: Aetna Medicare Advantage	$5,544.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,712.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,712.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,712.40
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.00

GRAFT AMNIO EXCEL 10CMX10CM

Facility

$18,480.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.00
Max. Negotiated Rate	$4,472.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.00

GRAFT AMNIO EXCEL 1.5 CM X 1.5

Facility

$2,310.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684015
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna Commercial	$693.00
Rate for Payer: Aetna Medicare Advantage	$693.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$589.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$589.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$589.05
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: Qualcare PPO/HMO/WC	$346.50

GRAFT AMNIO EXCEL 1.5 CM X 1.5

Facility

$2,310.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684015
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$559.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: Qualcare PPO/HMO/WC	$346.50

GRAFT AMNIOEXCEL 18 MM

Facility

$2,100.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684016
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$630.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

GRAFT AMNIOEXCEL 18 MM

Facility

$2,100.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684016
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

GRAFT AMNIO EXCEL 24 MM

Facility

$2,450.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684031
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

GRAFT AMNIO EXCEL 24 MM

Facility

$2,450.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684031
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$735.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

Know your out-of-pocket cost for care.

All Charges