Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AORTIC A28-28/C75

Facility

$17,475.00

Hospital Charge Code	270647243C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

GRAFT AORTIC EXT 34x34x80

Facility

$26,495.00

Hospital Charge Code	270677193
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 AORTIC EXT 34x34x80

Facility

$26,495.00

Hospital Charge Code	270677193
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 AORTIC EXTENSION

Facility

$20,475.00

Hospital Charge Code	270646000
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$10,237.50
Rate for Payer: Aetna Commercial	$6,142.50
Rate for Payer: Aetna Medicare Advantage	$6,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,221.12
Rate for Payer: Cigna Commercial	$10,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

GRAFT AORTIC EXTENSION

Facility

$20,475.00

Hospital Charge Code	270646000
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$4,954.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

GRAFT AORTIC EXTENSION CV100V

Facility

$24,775.00

Service Code	HCPCS C1768
Hospital Charge Code	270666862
Hospital Revenue Code	278
Min. Negotiated Rate	$3,716.25
Max. Negotiated Rate	$12,387.50
Rate for Payer: Aetna Commercial	$7,432.50
Rate for Payer: Aetna Medicare Advantage	$7,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,317.62
Rate for Payer: Cigna Commercial	$12,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,995.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,716.25

GRAFT AORTIC EXTENSION CV100V

Facility

$24,775.00

Service Code	HCPCS C1768
Hospital Charge Code	270666862
Hospital Revenue Code	278
Min. Negotiated Rate	$3,716.25
Max. Negotiated Rate	$5,995.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,995.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,716.25

GRAFT AORTIC EXT PROXIMAL

Facility

$19,450.00

Hospital Charge Code	270665549
Hospital Revenue Code	278
Min. Negotiated Rate	$2,917.50
Max. Negotiated Rate	$9,725.00
Rate for Payer: Aetna Commercial	$5,835.00
Rate for Payer: Aetna Medicare Advantage	$5,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,959.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,959.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,959.75
Rate for Payer: Cigna Commercial	$9,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,706.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,917.50

GRAFT AORTIC EXT PROXIMAL

Facility

$19,450.00

Hospital Charge Code	270665549
Hospital Revenue Code	278
Min. Negotiated Rate	$2,917.50
Max. Negotiated Rate	$4,706.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,706.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,917.50

GRAFT APX-FBR 10CC

Facility

$11,937.80

Service Code	HCPCS C9359
Hospital Charge Code	270692410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$5,968.90
Rate for Payer: Aetna Commercial	$3,581.34
Rate for Payer: Aetna Medicare Advantage	$3,581.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,044.14
Rate for Payer: Cigna Commercial	$5,968.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

GRAFT APX-FBR 10CC

Facility

$11,937.80

Service Code	HCPCS C9359
Hospital Charge Code	270692410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$2,888.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

GRAFT ARTEGRAFT 5 MM 34 CM

Facility

$7,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270690091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.25
Max. Negotiated Rate	$1,716.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25

GRAFT ARTEGRAFT 5 MM 34 CM

Facility

$7,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270690091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.25
Max. Negotiated Rate	$3,547.50
Rate for Payer: Aetna Commercial	$2,128.50
Rate for Payer: Aetna Medicare Advantage	$2,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.22
Rate for Payer: Cigna Commercial	$3,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25

GRAFT AVANCE NERVE 4-5x70MM

Facility

$24,125.00

Hospital Charge Code	270660289
Hospital Revenue Code	278
Min. Negotiated Rate	$3,618.75
Max. Negotiated Rate	$12,062.50
Rate for Payer: Aetna Commercial	$7,237.50
Rate for Payer: Aetna Medicare Advantage	$7,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,151.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,151.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,151.88
Rate for Payer: Cigna Commercial	$12,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,838.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,618.75

GRAFT AVANCE NERVE 4-5x70MM

Facility

$24,125.00

Hospital Charge Code	270660289
Hospital Revenue Code	278
Min. Negotiated Rate	$3,618.75
Max. Negotiated Rate	$5,838.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,838.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,618.75

GRAFT AX BI FEM 8mm 90cm/40cm

Facility

$13,430.00

Service Code	HCPCS C1768
Hospital Charge Code	270664526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,014.50
Max. Negotiated Rate	$6,715.00
Rate for Payer: Aetna Commercial	$4,029.00
Rate for Payer: Aetna Medicare Advantage	$4,029.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,686.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,424.65
Rate for Payer: Cigna Commercial	$6,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,014.50

GRAFT AX BI FEM 8mm 90cm/40cm

Facility

$13,430.00

Service Code	HCPCS C1768
Hospital Charge Code	270664526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,014.50
Max. Negotiated Rate	$3,250.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,686.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,014.50

GRAFT BG MAT S 300 2.5 CM

Facility

$6,140.00

Service Code	HCPCS Q4100
Hospital Charge Code	270700855
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$1,842.00
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

GRAFT BG MAT S 300 2.5 CM

Facility

$6,140.00

Service Code	HCPCS Q4100
Hospital Charge Code	270700855
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

GRAFT BIFURC TH WALL 16/8 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270638412
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,369.50
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIFURC TH WALL 16/8 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270638412
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$1,104.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIFURC TH/WALL 18/9 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270637984
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,369.50
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIFURC TH/WALL 18/9 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270637984
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$1,104.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIOBRACE 23MM

Facility

$19,250.00

Service Code	HCPCS C1781
Hospital Charge Code	270697767
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

GRAFT BIOBRACE 23MM

Facility

$19,250.00

Service Code	HCPCS C1781
Hospital Charge Code	270697767
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$5,775.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

Know your out-of-pocket cost for care.

All Charges