Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT HARVEST

Facility

$8,500.00

Hospital Charge Code	270667378
Hospital Revenue Code	272
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFT HEMAGARD 20mmx10mmX50cm

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679499
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$1,536.45
Rate for Payer: Aetna Commercial	$921.87
Rate for Payer: Aetna Medicare Advantage	$921.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.59
Rate for Payer: Cigna Commercial	$1,536.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMAGARD 20mmx10mmX50cm

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679499
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$743.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMAGARD 6MMX 20CM

Facility

$1,672.70

Service Code	HCPCS L8670
Hospital Charge Code	270690318
Hospital Revenue Code	278
Min. Negotiated Rate	$250.91
Max. Negotiated Rate	$404.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.79
Rate for Payer: Qualcare PPO/HMO/WC	$250.91

GRAFT HEMAGARD 6MMX 20CM

Facility

$1,672.70

Service Code	HCPCS L8670
Hospital Charge Code	270690318
Hospital Revenue Code	278
Min. Negotiated Rate	$250.91
Max. Negotiated Rate	$681.49
Rate for Payer: Aetna Commercial	$501.81
Rate for Payer: Aetna Medicare Advantage	$501.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.54
Rate for Payer: Cigna Commercial	$681.49
Rate for Payer: Cigna Medicare Advantage	$408.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.79
Rate for Payer: Qualcare PPO/HMO/WC	$250.91

GRAFT HEMASHEILD 14mmX7mmX40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270679500
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHEILD 14mmX7mmX40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270679500
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$983.33
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHIEDL DBL VELOUR

Facility

$630.00

Hospital Charge Code	270657728
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

GRAFT HEMASHIEDL DBL VELOUR

Facility

$630.00

Hospital Charge Code	270657728
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

GRAFT HEMASHIELD 16x8mm 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270617414
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$983.33
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHIELD 16x8mm 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270617414
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHIELD 18MMx9MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659991
Hospital Revenue Code	278
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: Qualcare PPO/HMO/WC	$609.00

GRAFT HEMASHIELD 18MMx9MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659991
Hospital Revenue Code	278
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$2,030.00
Rate for Payer: Aetna Commercial	$1,218.00
Rate for Payer: Aetna Medicare Advantage	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.30
Rate for Payer: Cigna Commercial	$2,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: Qualcare PPO/HMO/WC	$609.00

GRAFT HEMASHIELD 20mmX10mmX50c

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679501
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$1,536.45
Rate for Payer: Aetna Commercial	$921.87
Rate for Payer: Aetna Medicare Advantage	$921.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.59
Rate for Payer: Cigna Commercial	$1,536.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMASHIELD 20mmX10mmX50c

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679501
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$743.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMASHIELD 20x10MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659992
Hospital Revenue Code	278
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$2,030.00
Rate for Payer: Aetna Commercial	$1,218.00
Rate for Payer: Aetna Medicare Advantage	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.30
Rate for Payer: Cigna Commercial	$2,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: Qualcare PPO/HMO/WC	$609.00

GRAFT HEMASHIELD 20x10MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659992
Hospital Revenue Code	278
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: Qualcare PPO/HMO/WC	$609.00

GRAFT HEMASHIELD 24x12mm 40cm

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270657648
Hospital Revenue Code	278
Min. Negotiated Rate	$609.34
Max. Negotiated Rate	$983.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: Qualcare PPO/HMO/WC	$609.34

GRAFT HEMASHIELD 24x12mm 40cm

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270657648
Hospital Revenue Code	278
Min. Negotiated Rate	$609.34
Max. Negotiated Rate	$2,031.12
Rate for Payer: Aetna Commercial	$1,218.67
Rate for Payer: Aetna Medicare Advantage	$1,218.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.87
Rate for Payer: Cigna Commercial	$2,031.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: Qualcare PPO/HMO/WC	$609.34

GRAFT HEMASHIELD 28X30 175428P

Facility

$2,941.85

Hospital Charge Code	270623781
Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$1,470.92
Rate for Payer: Aetna Commercial	$882.55
Rate for Payer: Aetna Medicare Advantage	$882.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$588.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.17
Rate for Payer: Cigna Commercial	$1,470.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.93
Rate for Payer: Qualcare PPO/HMO/WC	$441.28

GRAFT HEMASHIELD 28X30 175428P

Facility

$2,941.85

Hospital Charge Code	270623781
Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$711.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$588.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.93
Rate for Payer: Qualcare PPO/HMO/WC	$441.28

GRAFT HEMASHIELD 8 X 15

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686403
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$885.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD 8 X 15

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686403
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD 8 X 30

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686402
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$885.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD 8 X 30

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686402
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

Know your out-of-pocket cost for care.

All Charges