Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT PATELLA RT PAR80

Facility

$56,875.50

Service Code	HCPCS C1713
Hospital Charge Code	270694007
Hospital Revenue Code	278
Min. Negotiated Rate	$8,531.33
Max. Negotiated Rate	$13,763.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,375.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,763.87
Rate for Payer: Qualcare PPO/HMO/WC	$8,531.33

GRAFT PLACENTAL TISSUE MATRIX

Facility

$9,500.00

Service Code	HCPCS Q4139
Hospital Charge Code	270673755
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

GRAFT PLACENTAL TISSUE MATRIX

Facility

$9,500.00

Service Code	HCPCS Q4139
Hospital Charge Code	270673755
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

GRAFT PREPERATION SET FEE

Facility

$500.00

Hospital Charge Code	270645772
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GRAFT PREPERATION SET FEE

Facility

$500.00

Hospital Charge Code	270645772
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GRAFT PREP STATION BASE

Facility

$3,125.00

Hospital Charge Code	270691451
Hospital Revenue Code	272
Min. Negotiated Rate	$406.25
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.25
Rate for Payer: Oxford Commercial	$1,562.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Commercial	$1,562.50

GRAFT PREP STATION BASE

Facility

$3,125.00

Hospital Charge Code	270691451
Hospital Revenue Code	272
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

GRAFT PRIMATRIX 20X25CM

Facility

$44,913.20

Service Code	HCPCS Q4110
Hospital Charge Code	270695270
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$13,473.96
Rate for Payer: Aetna Commercial	$13,473.96
Rate for Payer: Aetna Medicare Advantage	$13,473.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,452.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,452.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,982.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,452.87
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,868.99
Rate for Payer: Qualcare PPO/HMO/WC	$6,736.98

GRAFT PRIMATRIX 20X25CM

Facility

$44,913.20

Service Code	HCPCS Q4110
Hospital Charge Code	270695270
Hospital Revenue Code	278
Min. Negotiated Rate	$6,736.98
Max. Negotiated Rate	$10,868.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,982.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,868.99
Rate for Payer: Qualcare PPO/HMO/WC	$6,736.98

GRAFT PRIMATRIX 2x2cm

Facility

$2,125.00

Hospital Charge Code	270673683
Hospital Revenue Code	636
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

GRAFT PRIMATRIX 2x2cm

Facility

$2,125.00

Hospital Charge Code	270673683
Hospital Revenue Code	636
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

GRAFT PRIMATRIX 3x3cm

Facility

$2,480.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673684
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$744.00
Rate for Payer: Aetna Commercial	$744.00
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.40
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.16
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

GRAFT PRIMATRIX 3x3cm

Facility

$2,480.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673684
Hospital Revenue Code	278
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$600.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.16
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

GRAFT PRIMATRIX 4 X 4 CM

Facility

$4,989.40

Service Code	HCPCS Q4110
Hospital Charge Code	270689733
Hospital Revenue Code	278
Min. Negotiated Rate	$748.41
Max. Negotiated Rate	$1,207.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.43
Rate for Payer: Qualcare PPO/HMO/WC	$748.41

GRAFT PRIMATRIX 4 X 4 CM

Facility

$4,989.40

Service Code	HCPCS Q4110
Hospital Charge Code	270689733
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,496.82
Rate for Payer: Aetna Commercial	$1,496.82
Rate for Payer: Aetna Medicare Advantage	$1,496.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,272.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,272.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,272.30
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.43
Rate for Payer: Qualcare PPO/HMO/WC	$748.41

GRAFT PRIMATRIX 4X4 CM

Facility

$3,850.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684069
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$931.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

GRAFT PRIMATRIX 4X4 CM

Facility

$3,850.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684069
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,155.00
Rate for Payer: Aetna Commercial	$1,155.00
Rate for Payer: Aetna Medicare Advantage	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$981.75
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

GRAFT PRIMATRIX 4x4cm

Facility

$3,850.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673685
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$931.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

GRAFT PRIMATRIX 4x4cm

Facility

$3,850.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673685
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,155.00
Rate for Payer: Aetna Commercial	$1,155.00
Rate for Payer: Aetna Medicare Advantage	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$981.75
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

GRAFT PRIMATRIX 5x5CM/SQ CM

Facility

$4,460.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673686
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,338.00
Rate for Payer: Aetna Commercial	$1,338.00
Rate for Payer: Aetna Medicare Advantage	$1,338.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,137.30
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.32
Rate for Payer: Qualcare PPO/HMO/WC	$669.00

GRAFT PRIMATRIX 5x5CM/SQ CM

Facility

$4,460.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673686
Hospital Revenue Code	278
Min. Negotiated Rate	$669.00
Max. Negotiated Rate	$1,079.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.32
Rate for Payer: Qualcare PPO/HMO/WC	$669.00

GRAFT PRIMATRIX 5x5CM/SQ CM JW

Facility

$319.20

Hospital Charge Code	270673686W
Hospital Revenue Code	636
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$159.60
Rate for Payer: Aetna Commercial	$95.76
Rate for Payer: Aetna Medicare Advantage	$95.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.40
Rate for Payer: Cigna Commercial	$159.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.25
Rate for Payer: Qualcare PPO/HMO/WC	$47.88

GRAFT PRIMATRIX 5x5CM/SQ CM JW

Facility

$319.20

Hospital Charge Code	270673686W
Hospital Revenue Code	636
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$77.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.25
Rate for Payer: Qualcare PPO/HMO/WC	$47.88

GRAFT PRIMATRIX 6 X 6 CM

Facility

$6,560.00

Service Code	HCPCS Q4110
Hospital Charge Code	270682617
Hospital Revenue Code	278
Min. Negotiated Rate	$984.00
Max. Negotiated Rate	$1,587.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,587.52
Rate for Payer: Qualcare PPO/HMO/WC	$984.00

GRAFT PRIMATRIX 6 X 6 CM

Facility

$6,560.00

Service Code	HCPCS Q4110
Hospital Charge Code	270682617
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,968.00
Rate for Payer: Aetna Commercial	$1,968.00
Rate for Payer: Aetna Medicare Advantage	$1,968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,672.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,672.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,672.80
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,587.52
Rate for Payer: Qualcare PPO/HMO/WC	$984.00

Know your out-of-pocket cost for care.

All Charges