Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT HYBRID VASCULAR 6MMX5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT HYBRID VASCULAR 8MM 5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659756
Hospital Revenue Code	272
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$1,837.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT HYBRID VASCULAR 8MM 5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659756
Hospital Revenue Code	272
Min. Negotiated Rate	$1,592.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,592.50
Rate for Payer: Oxford Commercial	$6,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Commercial	$6,125.00

GRAFT HYBRID VASCULAR 8MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660000
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$6,950.00
Rate for Payer: Aetna Commercial	$4,170.00
Rate for Payer: Aetna Medicare Advantage	$4,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,544.50
Rate for Payer: Cigna Commercial	$6,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT HYBRID VASCULAR 8MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660000
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$3,363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT HYBRID VASCULAR 9MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660001
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$6,950.00
Rate for Payer: Aetna Commercial	$4,170.00
Rate for Payer: Aetna Medicare Advantage	$4,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,544.50
Rate for Payer: Cigna Commercial	$6,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT HYBRID VASCULAR 9MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660001
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$3,363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT IFUSE TORQ

Facility

$16,125.00

Hospital Charge Code	270701375
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$4,837.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

GRAFT IFUSE TORQ

Facility

$16,125.00

Hospital Charge Code	270701375
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

GRAFT ILIAC CREST WEDGE 500408

Facility

$4,835.25

Hospital Charge Code	270610881
Hospital Revenue Code	278
Min. Negotiated Rate	$725.29
Max. Negotiated Rate	$1,170.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.13
Rate for Payer: Qualcare PPO/HMO/WC	$725.29

GRAFT ILIAC CREST WEDGE 500408

Facility

$4,835.25

Hospital Charge Code	270610881
Hospital Revenue Code	278
Min. Negotiated Rate	$725.29
Max. Negotiated Rate	$2,417.62
Rate for Payer: Aetna Commercial	$1,450.58
Rate for Payer: Aetna Medicare Advantage	$1,450.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,232.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,232.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,232.99
Rate for Payer: Cigna Commercial	$2,417.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.13
Rate for Payer: Qualcare PPO/HMO/WC	$725.29

GRAFT ILIAC EXT 116-16/0885SA

Facility

$16,375.00

Hospital Charge Code	270665108
Hospital Revenue Code	278
Min. Negotiated Rate	$2,456.25
Max. Negotiated Rate	$3,962.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,962.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,456.25

GRAFT ILIAC EXT 116-16/0885SA

Facility

$16,375.00

Hospital Charge Code	270665108
Hospital Revenue Code	278
Min. Negotiated Rate	$2,456.25
Max. Negotiated Rate	$8,187.50
Rate for Payer: Aetna Commercial	$4,912.50
Rate for Payer: Aetna Medicare Advantage	$4,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,175.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,175.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,175.62
Rate for Payer: Cigna Commercial	$8,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,962.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,456.25

GRAFT ILIAC EXTENSION

Facility

$13,475.00

Hospital Charge Code	270646241
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$4,042.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

GRAFT ILIAC EXTENSION

Facility

$16,475.00

Hospital Charge Code	270647244C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$4,942.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

GRAFT ILIAC EXTENSION

Facility

$16,475.00

Hospital Charge Code	270647244C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

GRAFT ILIAC EXTENSION

Facility

$13,475.00

Hospital Charge Code	270646241
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

GRAFT ILIAC EXT I20-13/C88FSA

Facility

$16,900.00

Hospital Charge Code	270660507C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,535.00
Max. Negotiated Rate	$4,089.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00

GRAFT ILIAC EXT I20-13/C88FSA

Facility

$16,900.00

Hospital Charge Code	270660507C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,535.00
Max. Negotiated Rate	$8,450.00
Rate for Payer: Aetna Commercial	$5,070.00
Rate for Payer: Aetna Medicare Advantage	$5,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,309.50
Rate for Payer: Cigna Commercial	$8,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00

GRAFT ILIAC EXT IT20-13/C88F

Facility

$16,475.00

Hospital Charge Code	270647244
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$4,942.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

GRAFT ILIAC EXT IT20-13/C88F

Facility

$16,475.00

Hospital Charge Code	270647244
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

GRAFT ILIAC LIMB 14x14x120

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270677362
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$7,048.50
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14x14x120

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270677362
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14x14x140MM

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270678255
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$7,498.50
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

GRAFT ILIAC LIMB 14x14x140MM

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270678255
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

Know your out-of-pocket cost for care.

All Charges