Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT GTX 8MM 90CM V08090L****

Facility

$3,813.00

Hospital Charge Code	1603992
Hospital Revenue Code	278
Min. Negotiated Rate	$571.95
Max. Negotiated Rate	$1,906.50
Rate for Payer: Aetna Commercial	$1,143.90
Rate for Payer: Aetna Medicare Advantage	$1,143.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$972.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$972.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$762.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$972.32
Rate for Payer: Cigna Commercial	$1,906.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$922.75
Rate for Payer: Qualcare PPO/HMO/WC	$571.95

GRAFT GTX B 20-10 40CM SB2001

Facility

$2,880.85

Hospital Charge Code	270601137
Hospital Revenue Code	278
Min. Negotiated Rate	$432.13
Max. Negotiated Rate	$697.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.17
Rate for Payer: Qualcare PPO/HMO/WC	$432.13

GRAFT GTX B 20-10 40CM SB2001

Facility

$2,880.85

Hospital Charge Code	270601137
Hospital Revenue Code	278
Min. Negotiated Rate	$432.13
Max. Negotiated Rate	$1,440.42
Rate for Payer: Aetna Commercial	$864.25
Rate for Payer: Aetna Medicare Advantage	$864.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.62
Rate for Payer: Cigna Commercial	$1,440.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.17
Rate for Payer: Qualcare PPO/HMO/WC	$432.13

GRAFT GTX DBL VEL 10MM 113501

Facility

$4,562.45

Hospital Charge Code	270605531
Hospital Revenue Code	278
Min. Negotiated Rate	$684.37
Max. Negotiated Rate	$2,281.22
Rate for Payer: Aetna Commercial	$1,368.73
Rate for Payer: Aetna Medicare Advantage	$1,368.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,163.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,163.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$912.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,163.42
Rate for Payer: Cigna Commercial	$2,281.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.11
Rate for Payer: Qualcare PPO/HMO/WC	$684.37

GRAFT GTX DBL VEL 10MM 113501

Facility

$4,562.45

Hospital Charge Code	270605531
Hospital Revenue Code	278
Min. Negotiated Rate	$684.37
Max. Negotiated Rate	$1,104.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$912.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.11
Rate for Payer: Qualcare PPO/HMO/WC	$684.37

GRAFT GTX FEP TW REMOV RG*****

Facility

$5,198.00

Hospital Charge Code	1603950
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 GTX FEP TW REMOV RG*****

Facility

$5,198.00

Hospital Charge Code	1603950
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 GTX PCH 10 15 1310015020

Facility

$4,792.00

Hospital Charge Code	270605538
Hospital Revenue Code	278
Min. Negotiated Rate	$718.80
Max. Negotiated Rate	$1,159.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$958.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.66
Rate for Payer: Qualcare PPO/HMO/WC	$718.80

GRAFT GTX PCH 10 15 1310015020

Facility

$4,792.00

Hospital Charge Code	270605538
Hospital Revenue Code	278
Min. Negotiated Rate	$718.80
Max. Negotiated Rate	$2,396.00
Rate for Payer: Aetna Commercial	$1,437.60
Rate for Payer: Aetna Medicare Advantage	$1,437.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,221.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,221.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,221.96
Rate for Payer: Cigna Commercial	$2,396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.66
Rate for Payer: Qualcare PPO/HMO/WC	$718.80

GRAFT GTX R06020050L*********

Facility

$2,995.00

Hospital Charge Code	1604099
Hospital Revenue Code	278
Min. Negotiated Rate	$449.25
Max. Negotiated Rate	$724.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$724.79
Rate for Payer: Qualcare PPO/HMO/WC	$449.25

GRAFT GTX R06020050L*********

Facility

$2,995.00

Hospital Charge Code	1604099
Hospital Revenue Code	278
Min. Negotiated Rate	$449.25
Max. Negotiated Rate	$1,497.50
Rate for Payer: Aetna Commercial	$898.50
Rate for Payer: Aetna Medicare Advantage	$898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$763.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$763.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$763.73
Rate for Payer: Cigna Commercial	$1,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$724.79
Rate for Payer: Qualcare PPO/HMO/WC	$449.25

GRAFT GTX RG 6 45 SRD06005045L

Facility

$4,792.00

Hospital Charge Code	270601132
Hospital Revenue Code	278
Min. Negotiated Rate	$718.80
Max. Negotiated Rate	$1,159.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$958.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.66
Rate for Payer: Qualcare PPO/HMO/WC	$718.80

GRAFT GTX RG 6 45 SRD06005045L

Facility

$4,792.00

Hospital Charge Code	270601132
Hospital Revenue Code	278
Min. Negotiated Rate	$718.80
Max. Negotiated Rate	$2,396.00
Rate for Payer: Aetna Commercial	$1,437.60
Rate for Payer: Aetna Medicare Advantage	$1,437.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,221.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,221.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,221.96
Rate for Payer: Cigna Commercial	$2,396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.66
Rate for Payer: Qualcare PPO/HMO/WC	$718.80

GRAFT GTX RG 6 60 R06050060L**

Facility

$1,163.00

Hospital Charge Code	1607142
Hospital Revenue Code	278
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$581.50
Rate for Payer: Aetna Commercial	$348.90
Rate for Payer: Aetna Medicare Advantage	$348.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.56
Rate for Payer: Cigna Commercial	$581.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.45
Rate for Payer: Qualcare PPO/HMO/WC	$174.45

GRAFT GTX RG 6 60 R06050060L**

Facility

$1,163.00

Hospital Charge Code	1607142
Hospital Revenue Code	278
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$281.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.45
Rate for Payer: Qualcare PPO/HMO/WC	$174.45

GRAFT GTX RG 6 60 R06050060L

Facility

$3,284.00

Hospital Charge Code	270601148
Hospital Revenue Code	278
Min. Negotiated Rate	$492.60
Max. Negotiated Rate	$794.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.73
Rate for Payer: Qualcare PPO/HMO/WC	$492.60

GRAFT GTX RG 6 60 R06050060L

Facility

$3,284.00

Hospital Charge Code	270601148
Hospital Revenue Code	278
Min. Negotiated Rate	$492.60
Max. Negotiated Rate	$1,642.00
Rate for Payer: Aetna Commercial	$985.20
Rate for Payer: Aetna Medicare Advantage	$985.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$837.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$837.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$837.42
Rate for Payer: Cigna Commercial	$1,642.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.73
Rate for Payer: Qualcare PPO/HMO/WC	$492.60

GRAFT GTX RG 6 70 R06070070L

Facility

$4,400.85

Service Code	HCPCS C1768
Hospital Charge Code	270601146
Hospital Revenue Code	278
Min. Negotiated Rate	$660.13
Max. Negotiated Rate	$1,065.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.01
Rate for Payer: Qualcare PPO/HMO/WC	$660.13

GRAFT GTX RG 6 70 R06070070L

Facility

$4,400.85

Service Code	HCPCS C1768
Hospital Charge Code	270601146
Hospital Revenue Code	278
Min. Negotiated Rate	$660.13
Max. Negotiated Rate	$2,200.43
Rate for Payer: Aetna Commercial	$1,320.26
Rate for Payer: Aetna Medicare Advantage	$1,320.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.22
Rate for Payer: Cigna Commercial	$2,200.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.01
Rate for Payer: Qualcare PPO/HMO/WC	$660.13

GRAFT GTX RG 6 R06020050L

Facility

$2,712.00

Hospital Charge Code	270601131
Hospital Revenue Code	278
Min. Negotiated Rate	$406.80
Max. Negotiated Rate	$1,356.00
Rate for Payer: Aetna Commercial	$813.60
Rate for Payer: Aetna Medicare Advantage	$813.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$691.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$691.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$691.56
Rate for Payer: Cigna Commercial	$1,356.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.30
Rate for Payer: Qualcare PPO/HMO/WC	$406.80

GRAFT GTX RG 6 R06020050L

Facility

$2,712.00

Hospital Charge Code	270601131
Hospital Revenue Code	278
Min. Negotiated Rate	$406.80
Max. Negotiated Rate	$656.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.30
Rate for Payer: Qualcare PPO/HMO/WC	$406.80

GRAFT GTX RG 8 60 R08050060L**

Facility

$1,163.00

Hospital Charge Code	1607159
Hospital Revenue Code	278
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$581.50
Rate for Payer: Aetna Commercial	$348.90
Rate for Payer: Aetna Medicare Advantage	$348.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.56
Rate for Payer: Cigna Commercial	$581.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.45
Rate for Payer: Qualcare PPO/HMO/WC	$174.45

GRAFT GTX RG 8 60 R08050060L**

Facility

$1,163.00

Hospital Charge Code	1607159
Hospital Revenue Code	278
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$281.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.45
Rate for Payer: Qualcare PPO/HMO/WC	$174.45

GRAFT GTX RG 8 70 R08070070L**

Facility

$1,559.00

Hospital Charge Code	1607167
Hospital Revenue Code	278
Min. Negotiated Rate	$233.85
Max. Negotiated Rate	$377.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$311.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.28
Rate for Payer: Qualcare PPO/HMO/WC	$233.85

GRAFT GTX RG 8 70 R08070070L**

Facility

$1,559.00

Hospital Charge Code	1607167
Hospital Revenue Code	278
Min. Negotiated Rate	$233.85
Max. Negotiated Rate	$779.50
Rate for Payer: Aetna Commercial	$467.70
Rate for Payer: Aetna Medicare Advantage	$467.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$311.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.55
Rate for Payer: Cigna Commercial	$779.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.28
Rate for Payer: Qualcare PPO/HMO/WC	$233.85

Know your out-of-pocket cost for care.

All Charges