Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT MDX VASC 26 30 175426

Facility

$3,103.25

Hospital Charge Code	270623776
Hospital Revenue Code	278
Min. Negotiated Rate	$465.49
Max. Negotiated Rate	$750.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$620.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.99
Rate for Payer: Qualcare PPO/HMO/WC	$465.49

GRAFT MDX VASC 26 30 175426

Facility

$3,103.25

Hospital Charge Code	270623776
Hospital Revenue Code	278
Min. Negotiated Rate	$465.49
Max. Negotiated Rate	$1,551.62
Rate for Payer: Aetna Commercial	$930.98
Rate for Payer: Aetna Medicare Advantage	$930.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$791.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$791.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$620.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$791.33
Rate for Payer: Cigna Commercial	$1,551.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.99
Rate for Payer: Qualcare PPO/HMO/WC	$465.49

GRAFT MEMBRANE 2 x 3 MM

Facility

$2,800.00

Service Code	HCPCS Q4248
Hospital Charge Code	270696212
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$677.60
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

GRAFT MEMBRANE 2 x 3 MM

Facility

$2,800.00

Service Code	HCPCS Q4248
Hospital Charge Code	270696212
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$677.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$677.60
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

GRAFT MEMBRANE 4X6MM

Facility

$12,480.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694128
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.00
Max. Negotiated Rate	$3,020.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

GRAFT MEMBRANE 4X6MM

Facility

$12,480.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694128
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,744.00
Rate for Payer: Aetna Commercial	$3,744.00
Rate for Payer: Aetna Medicare Advantage	$3,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,182.40
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

GRAFT MEMBRANE RESTORE 4X4

Facility

$5,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270694127
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

GRAFT MEMBRANE RESTORE 4X4

Facility

$5,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270694127
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

GRAFT MEMBRANE WRAP 2X2CM

Facility

$3,960.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694504
Hospital Revenue Code	278
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$958.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: Qualcare PPO/HMO/WC	$594.00

GRAFT MEMBRANE WRAP 2X2CM

Facility

$3,960.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694504
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,188.00
Rate for Payer: Aetna Commercial	$1,188.00
Rate for Payer: Aetna Medicare Advantage	$1,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,009.80
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: Qualcare PPO/HMO/WC	$594.00

GRAFT MEMBRANE WRAP 4X6CM

Facility

$23,760.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694210
Hospital Revenue Code	278
Min. Negotiated Rate	$3,564.00
Max. Negotiated Rate	$5,749.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,749.92
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.00

GRAFT MEMBRANE WRAP 4X6CM

Facility

$23,760.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694210
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$7,128.00
Rate for Payer: Aetna Commercial	$7,128.00
Rate for Payer: Aetna Medicare Advantage	$7,128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,058.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,058.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,058.80
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,749.92
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.00

GRAFT MEMBRANE WRAP DUAL LAY 4

Facility

$15,840.00

Service Code	HCPCS C1762
Hospital Charge Code	270694209
Hospital Revenue Code	278
Min. Negotiated Rate	$2,376.00
Max. Negotiated Rate	$7,920.00
Rate for Payer: Aetna Commercial	$4,752.00
Rate for Payer: Aetna Medicare Advantage	$4,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,039.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,039.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,039.20
Rate for Payer: Cigna Commercial	$7,920.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,833.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,376.00

GRAFT MEMBRANE WRAP DUAL LAY 4

Facility

$15,840.00

Service Code	HCPCS C1762
Hospital Charge Code	270694209
Hospital Revenue Code	278
Min. Negotiated Rate	$2,376.00
Max. Negotiated Rate	$3,833.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,833.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,376.00

GRAFT MICRO STR 14mm30cm095214

Facility

$2,191.25

Hospital Charge Code	270615621
Hospital Revenue Code	278
Min. Negotiated Rate	$328.69
Max. Negotiated Rate	$530.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$438.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.28
Rate for Payer: Qualcare PPO/HMO/WC	$328.69

GRAFT MICRO STR 14mm30cm095214

Facility

$2,191.25

Hospital Charge Code	270615621
Hospital Revenue Code	278
Min. Negotiated Rate	$328.69
Max. Negotiated Rate	$1,095.62
Rate for Payer: Aetna Commercial	$657.38
Rate for Payer: Aetna Medicare Advantage	$657.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$438.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.77
Rate for Payer: Cigna Commercial	$1,095.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.28
Rate for Payer: Qualcare PPO/HMO/WC	$328.69

GRAFT MICRO STRAIT 10MMx60CM

Facility

$3,070.00

Hospital Charge Code	270630285
Hospital Revenue Code	278
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$742.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.94
Rate for Payer: Qualcare PPO/HMO/WC	$460.50

GRAFT MICRO STRAIT 10MMx60CM

Facility

$3,070.00

Hospital Charge Code	270630285
Hospital Revenue Code	278
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$1,535.00
Rate for Payer: Aetna Commercial	$921.00
Rate for Payer: Aetna Medicare Advantage	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$782.85
Rate for Payer: Cigna Commercial	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.94
Rate for Payer: Qualcare PPO/HMO/WC	$460.50

GRAFT MTF TENDON 100260

Facility

$4,804.00

Hospital Charge Code	270616220
Hospital Revenue Code	278
Min. Negotiated Rate	$720.60
Max. Negotiated Rate	$2,402.00
Rate for Payer: Aetna Commercial	$1,441.20
Rate for Payer: Aetna Medicare Advantage	$1,441.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,225.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,225.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,225.02
Rate for Payer: Cigna Commercial	$2,402.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,162.57
Rate for Payer: Qualcare PPO/HMO/WC	$720.60

GRAFT MTF TENDON 100260

Facility

$4,804.00

Hospital Charge Code	270616220
Hospital Revenue Code	278
Min. Negotiated Rate	$720.60
Max. Negotiated Rate	$1,162.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,162.57
Rate for Payer: Qualcare PPO/HMO/WC	$720.60

GRAFT NANOPUTTY OSTEOFLO 10CC

Facility

$27,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270692931
Hospital Revenue Code	278
Min. Negotiated Rate	$4,143.75
Max. Negotiated Rate	$13,812.50
Rate for Payer: Aetna Commercial	$8,287.50
Rate for Payer: Aetna Medicare Advantage	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,044.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,044.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,044.38
Rate for Payer: Cigna Commercial	$13,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,685.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,143.75

GRAFT NANOPUTTY OSTEOFLO 10CC

Facility

$27,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270692931
Hospital Revenue Code	278
Min. Negotiated Rate	$4,143.75
Max. Negotiated Rate	$6,685.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,685.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,143.75

GRAFT NEOX

Facility

$5,975.00

Service Code	HCPCS Q4156
Hospital Charge Code	270683169
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,792.50
Rate for Payer: Aetna Commercial	$1,792.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

GRAFT NEOX

Facility

$5,975.00

Service Code	HCPCS Q4156
Hospital Charge Code	270683169
Hospital Revenue Code	636
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

GRAFT NEOX 100MG

Facility

$5,750.00

Service Code	HCPCS Q4156
Hospital Charge Code	270683170
Hospital Revenue Code	636
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

Know your out-of-pocket cost for care.

All Charges