Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT FLUENCY 6x40mm FTL06040

Facility

$10,975.00

Hospital Charge Code	270637376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.25
Max. Negotiated Rate	$2,655.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25

GRAFT FLUENCY 6x40mm FTL06040

Facility

$12,050.00

Hospital Charge Code	270637376V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.50
Max. Negotiated Rate	$2,916.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,916.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.50

GRAFT FLUENCY 6x40mm FTL06040

Facility

$12,050.00

Hospital Charge Code	270637376V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.50
Max. Negotiated Rate	$6,025.00
Rate for Payer: Aetna Commercial	$3,615.00
Rate for Payer: Aetna Medicare Advantage	$3,615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,072.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,072.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,072.75
Rate for Payer: Cigna Commercial	$6,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,916.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.50

GRAFT FLUENCY 6x40mm FTL06040

Facility

$10,975.00

Hospital Charge Code	270637376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.25
Max. Negotiated Rate	$5,487.50
Rate for Payer: Aetna Commercial	$3,292.50
Rate for Payer: Aetna Medicare Advantage	$3,292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,798.62
Rate for Payer: Cigna Commercial	$5,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25

GRAFT GOR 12MMX40CM SBT1201

Facility

$4,310.25

Hospital Charge Code	270634307
Hospital Revenue Code	278
Min. Negotiated Rate	$646.54
Max. Negotiated Rate	$2,155.12
Rate for Payer: Aetna Commercial	$1,293.08
Rate for Payer: Aetna Medicare Advantage	$1,293.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,099.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,099.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,099.11
Rate for Payer: Cigna Commercial	$2,155.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.08
Rate for Payer: Qualcare PPO/HMO/WC	$646.54

GRAFT GOR 12MMX40CM SBT1201

Facility

$4,310.25

Hospital Charge Code	270634307
Hospital Revenue Code	278
Min. Negotiated Rate	$646.54
Max. Negotiated Rate	$1,043.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.08
Rate for Payer: Qualcare PPO/HMO/WC	$646.54

GRAFT GORE 10 MM 80CM

Facility

$6,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270660566
Hospital Revenue Code	278
Min. Negotiated Rate	$998.25
Max. Negotiated Rate	$3,327.50
Rate for Payer: Aetna Commercial	$1,996.50
Rate for Payer: Aetna Medicare Advantage	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,697.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,697.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,697.03
Rate for Payer: Cigna Commercial	$3,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,610.51
Rate for Payer: Qualcare PPO/HMO/WC	$998.25

GRAFT GORE 10 MM 80CM

Facility

$6,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270660566
Hospital Revenue Code	278
Min. Negotiated Rate	$998.25
Max. Negotiated Rate	$1,610.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,610.51
Rate for Payer: Qualcare PPO/HMO/WC	$998.25

GRAFT GORE-TEX 10MMX20CM

Facility

$4,100.00

Service Code	HCPCS C1768
Hospital Charge Code	270686063
Hospital Revenue Code	278
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$992.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.20
Rate for Payer: Qualcare PPO/HMO/WC	$615.00

GRAFT GORE-TEX 10MMX20CM

Facility

$4,100.00

Service Code	HCPCS C1768
Hospital Charge Code	270686063
Hospital Revenue Code	278
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Aetna Commercial	$1,230.00
Rate for Payer: Aetna Medicare Advantage	$1,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,045.50
Rate for Payer: Cigna Commercial	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.20
Rate for Payer: Qualcare PPO/HMO/WC	$615.00

GRAFT GORE-TEX 12MMX30CM

Facility

$5,245.00

Service Code	HCPCS C1768
Hospital Charge Code	270640429
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,573.50
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

GRAFT GORE-TEX 12MMX30CM

Facility

$5,245.00

Service Code	HCPCS C1768
Hospital Charge Code	270640429
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

GRAFT GORETEX 6mm 40cm

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270656771
Hospital Revenue Code	278
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$506.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.99
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

GRAFT GORETEX 6mm 40cm

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270656771
Hospital Revenue Code	278
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$1,047.50
Rate for Payer: Aetna Commercial	$628.50
Rate for Payer: Aetna Medicare Advantage	$628.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.23
Rate for Payer: Cigna Commercial	$1,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.99
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

GRAFT GORETEX 6 X 20 CM

Facility

$1,615.00

Service Code	HCPCS L8670
Hospital Charge Code	270690317
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$681.49
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$681.49
Rate for Payer: Cigna Medicare Advantage	$408.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

GRAFT GORETEX 6 X 20 CM

Facility

$1,615.00

Service Code	HCPCS L8670
Hospital Charge Code	270690317
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

GRAFT GORE-TEX 8MM X40CM STRCH

Facility

$4,230.00

Service Code	HCPCS L8670
Hospital Charge Code	270701372
Hospital Revenue Code	278
Min. Negotiated Rate	$408.89
Max. Negotiated Rate	$1,269.00
Rate for Payer: Aetna Commercial	$1,269.00
Rate for Payer: Aetna Medicare Advantage	$1,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,078.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,078.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,078.65
Rate for Payer: Cigna Commercial	$681.49
Rate for Payer: Cigna Medicare Advantage	$408.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.66
Rate for Payer: Qualcare PPO/HMO/WC	$634.50

GRAFT GORE-TEX 8MM X40CM STRCH

Facility

$4,230.00

Service Code	HCPCS L8670
Hospital Charge Code	270701372
Hospital Revenue Code	278
Min. Negotiated Rate	$634.50
Max. Negotiated Rate	$1,023.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.66
Rate for Payer: Qualcare PPO/HMO/WC	$634.50

GRAFT GORE-TEX 8MM X70CM STRCH

Facility

$4,360.00

Service Code	HCPCS C1768
Hospital Charge Code	270658086
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,308.00
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

GRAFT GORE-TEX 8MM X70CM STRCH

Facility

$4,360.00

Service Code	HCPCS C1768
Hospital Charge Code	270658086
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

GRAFT GORE-TEX LINED4-6MMX40CM

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270650758
Hospital Revenue Code	278
Min. Negotiated Rate	$357.75
Max. Negotiated Rate	$577.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$477.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.17
Rate for Payer: Qualcare PPO/HMO/WC	$357.75

GRAFT GORE-TEX LINED4-6MMX40CM

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270650758
Hospital Revenue Code	278
Min. Negotiated Rate	$357.75
Max. Negotiated Rate	$1,192.50
Rate for Payer: Aetna Commercial	$715.50
Rate for Payer: Aetna Medicare Advantage	$715.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$608.17
Rate for Payer: Cigna Commercial	$1,192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.17
Rate for Payer: Qualcare PPO/HMO/WC	$357.75

GRAFT GORETEX LINED 8mm 70cm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650757
Hospital Revenue Code	278
Min. Negotiated Rate	$524.25
Max. Negotiated Rate	$1,747.50
Rate for Payer: Aetna Commercial	$1,048.50
Rate for Payer: Aetna Medicare Advantage	$1,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$891.23
Rate for Payer: Cigna Commercial	$1,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: Qualcare PPO/HMO/WC	$524.25

GRAFT GORETEX LINED 8mm 70cm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650757
Hospital Revenue Code	278
Min. Negotiated Rate	$524.25
Max. Negotiated Rate	$845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: Qualcare PPO/HMO/WC	$524.25

GRAFT GORETEX PROPATEN 4-7mmID

Facility

$6,165.00

Service Code	HCPCS C1768
Hospital Charge Code	270643829
Hospital Revenue Code	278
Min. Negotiated Rate	$924.75
Max. Negotiated Rate	$1,491.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,233.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.93
Rate for Payer: Qualcare PPO/HMO/WC	$924.75

Know your out-of-pocket cost for care.

All Charges