Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT GTX RG 8 70 R08070070L

Facility

$8,415.00

Hospital Charge Code	270601133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.25
Max. Negotiated Rate	$2,036.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,683.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,036.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,262.25

GRAFT GTX RG 8 70 R08070070L

Facility

$8,415.00

Hospital Charge Code	270601133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.25
Max. Negotiated Rate	$4,207.50
Rate for Payer: Aetna Commercial	$2,524.50
Rate for Payer: Aetna Medicare Advantage	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,145.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,145.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,145.82
Rate for Payer: Cigna Commercial	$4,207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,036.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,262.25

GRAFT GTX RINGED*********

Facility

$1,559.00

Hospital Charge Code	1810050
Hospital Revenue Code	279
Min. Negotiated Rate	$233.85
Max. Negotiated Rate	$233.85
Rate for Payer: Qualcare PPO/HMO/WC	$233.85

GRAFT GTX RINGED*********

Facility

$1,559.00

Hospital Charge Code	1810050
Hospital Revenue Code	279
Min. Negotiated Rate	$202.67
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) PPO	$397.55
Rate for Payer: Cigna Commercial	$779.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.67
Rate for Payer: Oxford Commercial	$779.50
Rate for Payer: Qualcare PPO/HMO/WC	$233.85
Rate for Payer: UnitedHealthcare Commercial	$779.50

GRAFT GTX RTW 8 70 RT08050070L

Facility

$6,985.00

Hospital Charge Code	270601134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.75
Max. Negotiated Rate	$3,492.50
Rate for Payer: Aetna Commercial	$2,095.50
Rate for Payer: Aetna Medicare Advantage	$2,095.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,781.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,781.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,781.17
Rate for Payer: Cigna Commercial	$3,492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.75

GRAFT GTX RTW 8 70 RT08050070L

Facility

$6,985.00

Hospital Charge Code	270601134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.75
Max. Negotiated Rate	$1,690.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.75

GRAFT GTX STR SR006005045L****

Facility

$938.00

Hospital Charge Code	1607183
Hospital Revenue Code	278
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.70

GRAFT GTX STR SR006005045L****

Facility

$938.00

Hospital Charge Code	1607183
Hospital Revenue Code	278
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$469.00
Rate for Payer: Aetna Commercial	$281.40
Rate for Payer: Aetna Medicare Advantage	$281.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.19
Rate for Payer: Cigna Commercial	$469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.70

GRAFT GTX T2-VT08080L *******

Facility

$1,131.00

Hospital Charge Code	1607175
Hospital Revenue Code	251
Min. Negotiated Rate	$169.65
Max. Negotiated Rate	$169.65
Rate for Payer: Qualcare PPO/HMO/WC	$169.65

GRAFT GTX T2-VT08080L *******

Facility

$1,131.00

Hospital Charge Code	1607175
Hospital Revenue Code	251
Min. Negotiated Rate	$147.03
Max. Negotiated Rate	$565.50
Rate for Payer: Aetna Commercial	$339.30
Rate for Payer: Aetna Medicare Advantage	$339.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$288.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$288.40
Rate for Payer: Cigna Commercial	$565.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.03
Rate for Payer: Oxford Commercial	$565.50
Rate for Payer: Qualcare PPO/HMO/WC	$169.65
Rate for Payer: UnitedHealthcare Commercial	$565.50

GRAFT GTX TH WL 6 80 VT06080L*

Facility

$3,947.00

Hospital Charge Code	1604073
Hospital Revenue Code	278
Min. Negotiated Rate	$592.05
Max. Negotiated Rate	$955.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.17
Rate for Payer: Qualcare PPO/HMO/WC	$592.05

GRAFT GTX TH WL 6 80 VT06080L*

Facility

$3,947.00

Hospital Charge Code	1604073
Hospital Revenue Code	278
Min. Negotiated Rate	$592.05
Max. Negotiated Rate	$1,973.50
Rate for Payer: Aetna Commercial	$1,184.10
Rate for Payer: Aetna Medicare Advantage	$1,184.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,006.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,006.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,006.49
Rate for Payer: Cigna Commercial	$1,973.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.17
Rate for Payer: Qualcare PPO/HMO/WC	$592.05

GRAFT GTX TH WL 6 80 VT06080L

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270601130
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 GTX TH WL 6 80 VT06080L

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270601130
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 GTX TH WL 6 90 ********

Facility

$5,064.00

Hospital Charge Code	1604123
Hospital Revenue Code	278
Min. Negotiated Rate	$759.60
Max. Negotiated Rate	$2,532.00
Rate for Payer: Aetna Commercial	$1,519.20
Rate for Payer: Aetna Medicare Advantage	$1,519.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,291.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,291.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,012.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,291.32
Rate for Payer: Cigna Commercial	$2,532.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.49
Rate for Payer: Qualcare PPO/HMO/WC	$759.60

GRAFT GTX TH WL 6 90 ********

Facility

$5,064.00

Hospital Charge Code	1604123
Hospital Revenue Code	278
Min. Negotiated Rate	$759.60
Max. Negotiated Rate	$1,225.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,012.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.49
Rate for Payer: Qualcare PPO/HMO/WC	$759.60

GRAFT GTX TH WL 8 80 VT08080L

Facility

$3,356.85

Hospital Charge Code	270605530
Hospital Revenue Code	278
Min. Negotiated Rate	$503.53
Max. Negotiated Rate	$812.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$671.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$812.36
Rate for Payer: Qualcare PPO/HMO/WC	$503.53

GRAFT GTX TH WL 8 80 VT08080L

Facility

$3,356.85

Hospital Charge Code	270605530
Hospital Revenue Code	278
Min. Negotiated Rate	$503.53
Max. Negotiated Rate	$1,678.42
Rate for Payer: Aetna Commercial	$1,007.05
Rate for Payer: Aetna Medicare Advantage	$1,007.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$671.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.00
Rate for Payer: Cigna Commercial	$1,678.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$812.36
Rate for Payer: Qualcare PPO/HMO/WC	$503.53

GRAFT GTX TH WL R 8X70CM******

Facility

$4,441.00

Hospital Charge Code	1603935
Hospital Revenue Code	278
Min. Negotiated Rate	$666.15
Max. Negotiated Rate	$1,074.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.72
Rate for Payer: Qualcare PPO/HMO/WC	$666.15

GRAFT GTX TH WL R 8X70CM******

Facility

$4,441.00

Hospital Charge Code	1603935
Hospital Revenue Code	278
Min. Negotiated Rate	$666.15
Max. Negotiated Rate	$2,220.50
Rate for Payer: Aetna Commercial	$1,332.30
Rate for Payer: Aetna Medicare Advantage	$1,332.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.45
Rate for Payer: Cigna Commercial	$2,220.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.72
Rate for Payer: Qualcare PPO/HMO/WC	$666.15

GRAFTGUN CARTRIDGE KIT

Facility

$6,875.00

Hospital Charge Code	270692127
Hospital Revenue Code	272
Min. Negotiated Rate	$893.75
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,062.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$893.75
Rate for Payer: Oxford Commercial	$3,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Commercial	$3,437.50

GRAFTGUN CARTRIDGE KIT

Facility

$6,875.00

Hospital Charge Code	270692127
Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

GRAFTGUN UNIV GDS GRAFT DEL SY

Facility

$6,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270691275
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

GRAFTGUN UNIV GDS GRAFT DEL SY

Facility

$6,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270691275
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

GRAFT HARVEST

Facility

$8,500.00

Hospital Charge Code	270667378
Hospital Revenue Code	272
Min. Negotiated Rate	$1,105.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.00
Rate for Payer: Oxford Commercial	$4,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Commercial	$4,250.00

Know your out-of-pocket cost for care.

All Charges