Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT EPIFIX 2.0x3.0CM

Facility

$5,720.00

Service Code	HCPCS Q4186
Hospital Charge Code	270658379
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,716.00
Rate for Payer: Aetna Commercial	$1,716.00
Rate for Payer: Aetna Medicare Advantage	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,458.60
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

GRAFT EPIFIX 2.0x3.0CM/SQCM JW

Facility

$1,104.17

Hospital Charge Code	270658379W
Hospital Revenue Code	636
Min. Negotiated Rate	$165.63
Max. Negotiated Rate	$267.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.21
Rate for Payer: Qualcare PPO/HMO/WC	$165.63

GRAFT EPIFIX 2.0x3.0CM/SQCM JW

Facility

$1,104.17

Hospital Charge Code	270658379W
Hospital Revenue Code	636
Min. Negotiated Rate	$165.63
Max. Negotiated Rate	$552.09
Rate for Payer: Aetna Commercial	$331.25
Rate for Payer: Aetna Medicare Advantage	$331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.56
Rate for Payer: Cigna Commercial	$552.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.21
Rate for Payer: Qualcare PPO/HMO/WC	$165.63

GRAFT EPIFIX 4.0x4.5CM

Facility

$6,970.00

Service Code	HCPCS Q4186
Hospital Charge Code	270680653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.50
Max. Negotiated Rate	$1,686.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,686.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,045.50

GRAFT EPIFIX 4.0x4.5CM

Facility

$6,970.00

Service Code	HCPCS Q4186
Hospital Charge Code	270680653
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,091.00
Rate for Payer: Aetna Commercial	$2,091.00
Rate for Payer: Aetna Medicare Advantage	$2,091.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,777.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,777.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,394.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,777.35
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,686.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,045.50

GRAFT EXCLUDER AAA ENDOPRO CL

Facility

$23,695.00

Hospital Charge Code	270683789
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

GRAFT EXCLUDER AAA ENDOPRO CL

Facility

$23,695.00

Hospital Charge Code	270683789
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$11,847.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: Aetna Commercial	$7,108.50
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19

GRAFT EXCLUDER AAA ENDOPRO MB

Facility

$57,785.00

Hospital Charge Code	270683788
Hospital Revenue Code	278
Min. Negotiated Rate	$8,667.75
Max. Negotiated Rate	$13,983.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75

GRAFT EXCLUDER AAA ENDOPRO MB

Facility

$57,785.00

Hospital Charge Code	270683788
Hospital Revenue Code	278
Min. Negotiated Rate	$8,667.75
Max. Negotiated Rate	$28,892.50
Rate for Payer: Aetna Commercial	$17,335.50
Rate for Payer: Aetna Medicare Advantage	$17,335.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,735.17
Rate for Payer: Cigna Commercial	$28,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75

GRAFT EXTENDER ILIAC PXL161007

Facility

$13,550.00

Hospital Charge Code	270635534V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,032.50
Max. Negotiated Rate	$6,775.00
Rate for Payer: Aetna Commercial	$4,065.00
Rate for Payer: Aetna Medicare Advantage	$4,065.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.25
Rate for Payer: Cigna Commercial	$6,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,279.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,032.50

GRAFT EXTENDER ILIAC PXL161007

Facility

$13,550.00

Hospital Charge Code	270635534V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,032.50
Max. Negotiated Rate	$3,279.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,279.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,032.50

GRAFT EXTENDER ILIAC PXL161007

Facility

$11,427.90

Hospital Charge Code	270635534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,714.18
Max. Negotiated Rate	$5,713.95
Rate for Payer: Aetna Commercial	$3,428.37
Rate for Payer: Aetna Medicare Advantage	$3,428.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,914.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,914.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,914.11
Rate for Payer: Cigna Commercial	$5,713.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.18

GRAFT EXTENDER ILIAC PXL161007

Facility

$11,427.90

Hospital Charge Code	270635534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,714.18
Max. Negotiated Rate	$2,765.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.18

GRAFT EXTREMITY 4CC INJECTABLE

Facility

$10,350.00

Hospital Charge Code	270656821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$2,504.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,504.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50

GRAFT EXTREMITY 4CC INJECTABLE

Facility

$10,350.00

Hospital Charge Code	270656821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$5,175.00
Rate for Payer: Aetna Commercial	$3,105.00
Rate for Payer: Aetna Medicare Advantage	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,639.25
Rate for Payer: Cigna Commercial	$5,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,504.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50

GRAFT FEP RING 10MM X 80CM

Facility

$7,100.00

Hospital Charge Code	270637443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$1,718.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,065.00

GRAFT FEP RING 10MM X 80CM

Facility

$7,100.00

Hospital Charge Code	270637443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$3,550.00
Rate for Payer: Aetna Commercial	$2,130.00
Rate for Payer: Aetna Medicare Advantage	$2,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,810.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,810.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,810.50
Rate for Payer: Cigna Commercial	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,718.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,065.00

GRAFT FEP RINGED THIN WALLED

Facility

$6,355.00

Service Code	HCPCS C1768
Hospital Charge Code	270601127
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$1,537.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

GRAFT FEP RINGED THIN WALLED

Facility

$6,355.00

Service Code	HCPCS C1768
Hospital Charge Code	270601127
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$3,177.50
Rate for Payer: Aetna Commercial	$1,906.50
Rate for Payer: Aetna Medicare Advantage	$1,906.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.53
Rate for Payer: Cigna Commercial	$3,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

GRAFT FEP RING TW 060300802***

Facility

$5,198.00

Hospital Charge Code	1604057
Hospital Revenue Code	278
Min. Negotiated Rate	$779.70
Max. Negotiated Rate	$2,599.00
Rate for Payer: Aetna Commercial	$1,559.40
Rate for Payer: Aetna Medicare Advantage	$1,559.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.49
Rate for Payer: Cigna Commercial	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.92
Rate for Payer: Qualcare PPO/HMO/WC	$779.70

GRAFT FEP RING TW 060300802***

Facility

$5,198.00

Hospital Charge Code	1604057
Hospital Revenue Code	278
Min. Negotiated Rate	$779.70
Max. Negotiated Rate	$1,257.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.92
Rate for Payer: Qualcare PPO/HMO/WC	$779.70

GRAFT FILLER PRO-DENSE 2CC

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270700484
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,079.00
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

GRAFT FILLER PRO-DENSE 2CC

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270700484
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

GRAFT FLIXENE 6MMX40CM

Facility

$5,695.65

Service Code	HCPCS C1768
Hospital Charge Code	270689834
Hospital Revenue Code	278
Min. Negotiated Rate	$854.35
Max. Negotiated Rate	$2,847.82
Rate for Payer: Aetna Commercial	$1,708.69
Rate for Payer: Aetna Medicare Advantage	$1,708.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.39
Rate for Payer: Cigna Commercial	$2,847.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.35
Rate for Payer: Qualcare PPO/HMO/WC	$854.35

GRAFT FLIXENE 6MMX40CM

Facility

$5,695.65

Service Code	HCPCS C1768
Hospital Charge Code	270689834
Hospital Revenue Code	278
Min. Negotiated Rate	$854.35
Max. Negotiated Rate	$1,378.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.35
Rate for Payer: Qualcare PPO/HMO/WC	$854.35

Know your out-of-pocket cost for care.

All Charges