Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT NEOX 100MG

Facility

$5,750.00

Service Code	HCPCS Q4156
Hospital Charge Code	270683170
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,725.00
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) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

GRAFT NERVE 2-3X70 AVANCE

Facility

$23,000.00

Hospital Charge Code	270663369
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$6,900.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

GRAFT NERVE 2-3X70 AVANCE

Facility

$23,000.00

Hospital Charge Code	270663369
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$5,566.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

GRAFT NERVE PROTECTOR 7x40MM

Facility

$12,600.00

Hospital Charge Code	270661365
Hospital Revenue Code	278
Min. Negotiated Rate	$1,890.00
Max. Negotiated Rate	$6,300.00
Rate for Payer: Aetna Commercial	$3,780.00
Rate for Payer: Aetna Medicare Advantage	$3,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,213.00
Rate for Payer: Cigna Commercial	$6,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,049.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,890.00

GRAFT NERVE PROTECTOR 7x40MM

Facility

$12,600.00

Hospital Charge Code	270661365
Hospital Revenue Code	278
Min. Negotiated Rate	$1,890.00
Max. Negotiated Rate	$3,049.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,049.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,890.00

GRAFT NEURAGEN 3MMX2CM NERVE

Facility

$4,732.50

Service Code	HCPCS C9352
Hospital Charge Code	270684066
Hospital Revenue Code	278
Min. Negotiated Rate	$709.88
Max. Negotiated Rate	$1,145.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.27
Rate for Payer: Qualcare PPO/HMO/WC	$709.88

GRAFT NEURAGEN 3MMX2CM NERVE

Facility

$4,732.50

Service Code	HCPCS C9352
Hospital Charge Code	270684066
Hospital Revenue Code	278
Min. Negotiated Rate	$709.88
Max. Negotiated Rate	$2,366.25
Rate for Payer: Aetna Commercial	$1,419.75
Rate for Payer: Aetna Medicare Advantage	$1,419.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,206.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,206.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,206.79
Rate for Payer: Cigna Commercial	$2,366.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.27
Rate for Payer: Qualcare PPO/HMO/WC	$709.88

GRAFT NEURAGEN GUIDE 2MMX2CM

Facility

$4,732.50

Service Code	HCPCS C9352
Hospital Charge Code	270684068
Hospital Revenue Code	278
Min. Negotiated Rate	$709.88
Max. Negotiated Rate	$2,366.25
Rate for Payer: Aetna Commercial	$1,419.75
Rate for Payer: Aetna Medicare Advantage	$1,419.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,206.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,206.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,206.79
Rate for Payer: Cigna Commercial	$2,366.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.27
Rate for Payer: Qualcare PPO/HMO/WC	$709.88

GRAFT NEURAGEN GUIDE 2MMX2CM

Facility

$4,732.50

Service Code	HCPCS C9352
Hospital Charge Code	270684068
Hospital Revenue Code	278
Min. Negotiated Rate	$709.88
Max. Negotiated Rate	$1,145.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.27
Rate for Payer: Qualcare PPO/HMO/WC	$709.88

GRAFT NEURAWRAP 10MMX4CM NERVE

Facility

$6,542.50

Service Code	HCPCS C9353
Hospital Charge Code	270684067
Hospital Revenue Code	278
Min. Negotiated Rate	$981.38
Max. Negotiated Rate	$1,583.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.29
Rate for Payer: Qualcare PPO/HMO/WC	$981.38

GRAFT NEURAWRAP 10MMX4CM NERVE

Facility

$6,542.50

Service Code	HCPCS C9353
Hospital Charge Code	270684067
Hospital Revenue Code	278
Min. Negotiated Rate	$981.38
Max. Negotiated Rate	$3,271.25
Rate for Payer: Aetna Commercial	$1,962.75
Rate for Payer: Aetna Medicare Advantage	$1,962.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,668.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,668.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,668.34
Rate for Payer: Cigna Commercial	$3,271.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.29
Rate for Payer: Qualcare PPO/HMO/WC	$981.38

GRAFT NEUROWRAP 3MM X 20CM

Facility

$4,777.50

Service Code	HCPCS C9361
Hospital Charge Code	270688282
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,433.25
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

GRAFT NEUROWRAP 3MM X 20CM

Facility

$4,777.50

Service Code	HCPCS C9361
Hospital Charge Code	270688282
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

GRAFT NEVOS SPONGE 50X20X5MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692930
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$4,125.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

GRAFT NEVOS SPONGE 50X20X5MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692930
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

GRAFT NU SHIELD 6 SQ CM

Facility

$3,975.00

Service Code	HCPCS Q4160
Hospital Charge Code	270686858
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GRAFT NU SHIELD 6 SQ CM

Facility

$3,975.00

Service Code	HCPCS Q4160
Hospital Charge Code	270686858
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,192.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GRAFT OMNIGRAFT 2.5CM X 2.5 CM

Facility

$2,975.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684011
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$892.50
Rate for Payer: Aetna Commercial	$892.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

GRAFT OMNIGRAFT 2.5CM X 2.5 CM

Facility

$2,975.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684011
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$719.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012W
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012W
Hospital Revenue Code	636
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 7 CM X 7 CM

Facility

$8,750.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684013
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

GRAFT OMNIGRAFT 7 CM X 7 CM

Facility

$8,750.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

Know your out-of-pocket cost for care.

All Charges