Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT DBL VEL VASC 8x60 095208

Facility

$2,605.60

Hospital Charge Code	270630284
Hospital Revenue Code	278
Min. Negotiated Rate	$390.84
Max. Negotiated Rate	$630.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$521.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.56
Rate for Payer: Qualcare PPO/HMO/WC	$390.84

GRAFT DBL VEL VASC 8x60 095208

Facility

$2,605.60

Hospital Charge Code	270630284
Hospital Revenue Code	278
Min. Negotiated Rate	$390.84
Max. Negotiated Rate	$1,302.80
Rate for Payer: Aetna Commercial	$781.68
Rate for Payer: Aetna Medicare Advantage	$781.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$664.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$664.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$521.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$664.43
Rate for Payer: Cigna Commercial	$1,302.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.56
Rate for Payer: Qualcare PPO/HMO/WC	$390.84

GRAFT DBM PRIME HD 2.5ML LF

Facility

$1,290.00

Service Code	HCPCS C1762
Hospital Charge Code	270698873
Hospital Revenue Code	278
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$312.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$258.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.18
Rate for Payer: Qualcare PPO/HMO/WC	$193.50

GRAFT DBM PRIME HD 2.5ML LF

Facility

$1,290.00

Service Code	HCPCS C1762
Hospital Charge Code	270698873
Hospital Revenue Code	278
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$645.00
Rate for Payer: Aetna Commercial	$387.00
Rate for Payer: Aetna Medicare Advantage	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.95
Rate for Payer: Cigna Commercial	$645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.18
Rate for Payer: Qualcare PPO/HMO/WC	$193.50

GRAFT DBM SPONGE SMALL

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690648
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT DBM SPONGE SMALL

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690648
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT DCELL DERMIS 40x70x1.5MM

Facility

$10,808.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659719
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,242.40
Rate for Payer: Aetna Commercial	$3,242.40
Rate for Payer: Aetna Medicare Advantage	$3,242.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,756.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,756.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,756.04
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,615.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,621.20

GRAFT DCELL DERMIS 40x70x1.5MM

Facility

$10,808.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,615.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,161.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,615.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,621.20

GRAFT DECELL DERM 35x35x1.5MM

Facility

$9,092.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659716
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,727.60
Rate for Payer: Aetna Commercial	$2,727.60
Rate for Payer: Aetna Medicare Advantage	$2,727.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,318.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,318.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,318.46
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,200.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,363.80

GRAFT DECELL DERM 35x35x1.5MM

Facility

$9,092.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659716
Hospital Revenue Code	636
Min. Negotiated Rate	$1,363.80
Max. Negotiated Rate	$2,200.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,200.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,363.80

GRAFT DECELL DERM 50x90MM

Facility

$18,355.00

Hospital Charge Code	270677582
Hospital Revenue Code	278
Min. Negotiated Rate	$2,753.25
Max. Negotiated Rate	$9,177.50
Rate for Payer: Aetna Commercial	$5,506.50
Rate for Payer: Aetna Medicare Advantage	$5,506.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,680.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,680.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,671.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,680.52
Rate for Payer: Cigna Commercial	$9,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,441.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,753.25

GRAFT DECELL DERM 50x90MM

Facility

$18,355.00

Hospital Charge Code	270677582
Hospital Revenue Code	278
Min. Negotiated Rate	$2,753.25
Max. Negotiated Rate	$4,441.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,441.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,753.25

GRAFT DECELL DERMIS 35x35x2MM

Facility

$12,260.00

Hospital Charge Code	270657238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.00
Max. Negotiated Rate	$2,966.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,452.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,966.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.00

GRAFT DECELL DERMIS 35x35x2MM

Facility

$12,260.00

Hospital Charge Code	270657238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.00
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$3,678.00
Rate for Payer: Aetna Medicare Advantage	$3,678.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,126.30
Rate for Payer: Cigna Commercial	$6,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,966.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.00

GRAFT DELIVERY KIT

Facility

$3,050.00

Hospital Charge Code	270650007
Hospital Revenue Code	272
Min. Negotiated Rate	$457.50
Max. Negotiated Rate	$457.50
Rate for Payer: Qualcare PPO/HMO/WC	$457.50

GRAFT DELIVERY KIT

Facility

$3,050.00

Hospital Charge Code	270650007
Hospital Revenue Code	272
Min. Negotiated Rate	$396.50
Max. Negotiated Rate	$1,525.00
Rate for Payer: Aetna Commercial	$915.00
Rate for Payer: Aetna Medicare Advantage	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.75
Rate for Payer: Cigna Commercial	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.50
Rate for Payer: Oxford Commercial	$1,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$457.50
Rate for Payer: UnitedHealthcare Commercial	$1,525.00

GRAFT DEVELL DERMIS 30X40X.5MM

Facility

$4,708.00

Service Code	HCPCS Q4125
Hospital Charge Code	270674076
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,412.40
Rate for Payer: Aetna Commercial	$1,412.40
Rate for Payer: Aetna Medicare Advantage	$1,412.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$941.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,200.54
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,139.34
Rate for Payer: Qualcare PPO/HMO/WC	$706.20

GRAFT DEVELL DERMIS 30X40X.5MM

Facility

$4,708.00

Service Code	HCPCS Q4125
Hospital Charge Code	270674076
Hospital Revenue Code	278
Min. Negotiated Rate	$706.20
Max. Negotiated Rate	$1,139.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$941.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,139.34
Rate for Payer: Qualcare PPO/HMO/WC	$706.20

GRAFT DURAGEN 3 X3

Facility

$4,081.45

Service Code	HCPCS C1889
Hospital Charge Code	270690203
Hospital Revenue Code	278
Min. Negotiated Rate	$612.22
Max. Negotiated Rate	$2,040.72
Rate for Payer: Aetna Commercial	$1,224.43
Rate for Payer: Aetna Medicare Advantage	$1,224.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.77
Rate for Payer: Cigna Commercial	$2,040.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.71
Rate for Payer: Qualcare PPO/HMO/WC	$612.22

GRAFT DURAGEN 3 X3

Facility

$4,081.45

Service Code	HCPCS C1889
Hospital Charge Code	270690203
Hospital Revenue Code	278
Min. Negotiated Rate	$612.22
Max. Negotiated Rate	$987.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.71
Rate for Payer: Qualcare PPO/HMO/WC	$612.22

GRAFT DURAL IMPLANT 1X1 DURAFO

Facility

$4,840.00

Hospital Charge Code	270663921
Hospital Revenue Code	278
Min. Negotiated Rate	$726.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Aetna Commercial	$1,452.00
Rate for Payer: Aetna Medicare Advantage	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.20
Rate for Payer: Cigna Commercial	$2,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.28
Rate for Payer: Qualcare PPO/HMO/WC	$726.00

GRAFT DURAL IMPLANT 1X1 DURAFO

Facility

$4,840.00

Hospital Charge Code	270663921
Hospital Revenue Code	278
Min. Negotiated Rate	$726.00
Max. Negotiated Rate	$1,171.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.28
Rate for Payer: Qualcare PPO/HMO/WC	$726.00

GRAFT ENDO EXC 12x16 PXT261216

Facility

$38,895.00

Hospital Charge Code	270639870V
Hospital Revenue Code	278
Min. Negotiated Rate	$5,834.25
Max. Negotiated Rate	$19,447.50
Rate for Payer: Aetna Commercial	$11,668.50
Rate for Payer: Aetna Medicare Advantage	$11,668.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,918.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,918.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,918.23
Rate for Payer: Cigna Commercial	$19,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,412.59
Rate for Payer: Qualcare PPO/HMO/WC	$5,834.25

GRAFT ENDO EXC 12x16 PXT261216

Facility

$38,895.00

Hospital Charge Code	270639870V
Hospital Revenue Code	278
Min. Negotiated Rate	$5,834.25
Max. Negotiated Rate	$9,412.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,412.59
Rate for Payer: Qualcare PPO/HMO/WC	$5,834.25

GRAFT EPIFIX 2.0x3.0CM

Facility

$5,720.00

Service Code	HCPCS Q4186
Hospital Charge Code	270658379
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

Know your out-of-pocket cost for care.

All Charges