Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT STENT ILIAC LIMB14X10X16

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690575
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385C
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$19,738.50
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$19,738.50
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385C
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STRETCH 4-6mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270601149
Hospital Revenue Code	278
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$752.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50

GRAFT STRETCH 4-6mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270601149
Hospital Revenue Code	278
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$1,555.00
Rate for Payer: Aetna Commercial	$933.00
Rate for Payer: Aetna Medicare Advantage	$933.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$793.05
Rate for Payer: Cigna Commercial	$1,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50

GRAFT STRETCH 4-7MM 40CM

Facility

$2,885.00

Service Code	HCPCS C1768
Hospital Charge Code	270691573
Hospital Revenue Code	278
Min. Negotiated Rate	$432.75
Max. Negotiated Rate	$698.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$577.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.17
Rate for Payer: Qualcare PPO/HMO/WC	$432.75

GRAFT STRETCH 4-7MM 40CM

Facility

$2,885.00

Service Code	HCPCS C1768
Hospital Charge Code	270691573
Hospital Revenue Code	278
Min. Negotiated Rate	$432.75
Max. Negotiated Rate	$1,442.50
Rate for Payer: Aetna Commercial	$865.50
Rate for Payer: Aetna Medicare Advantage	$865.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$735.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$735.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$577.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$735.67
Rate for Payer: Cigna Commercial	$1,442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.17
Rate for Payer: Qualcare PPO/HMO/WC	$432.75

GRAFT STRETCH 4-7mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270605300
Hospital Revenue Code	278
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$752.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50

GRAFT STRETCH 4-7mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270605300
Hospital Revenue Code	278
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$1,555.00
Rate for Payer: Aetna Commercial	$933.00
Rate for Payer: Aetna Medicare Advantage	$933.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$793.05
Rate for Payer: Cigna Commercial	$1,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50

GRAFT STRETCH 6mm 40cm

Facility

$2,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270601128
Hospital Revenue Code	278
Min. Negotiated Rate	$398.25
Max. Negotiated Rate	$642.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$531.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$642.51
Rate for Payer: Qualcare PPO/HMO/WC	$398.25

GRAFT STRETCH 6mm 40cm

Facility

$2,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270601128
Hospital Revenue Code	278
Min. Negotiated Rate	$398.25
Max. Negotiated Rate	$1,327.50
Rate for Payer: Aetna Commercial	$796.50
Rate for Payer: Aetna Medicare Advantage	$796.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$677.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$677.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$531.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$677.02
Rate for Payer: Cigna Commercial	$1,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$642.51
Rate for Payer: Qualcare PPO/HMO/WC	$398.25

GRAFT STRETCH 6MMX40CM

Facility

$2,555.00

Hospital Charge Code	270654642
Hospital Revenue Code	278
Min. Negotiated Rate	$383.25
Max. Negotiated Rate	$618.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$511.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.31
Rate for Payer: Qualcare PPO/HMO/WC	$383.25

GRAFT STRETCH 6MMX40CM

Facility

$2,555.00

Hospital Charge Code	270654642
Hospital Revenue Code	278
Min. Negotiated Rate	$383.25
Max. Negotiated Rate	$1,277.50
Rate for Payer: Aetna Commercial	$766.50
Rate for Payer: Aetna Medicare Advantage	$766.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$511.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$651.52
Rate for Payer: Cigna Commercial	$1,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.31
Rate for Payer: Qualcare PPO/HMO/WC	$383.25

GRAFT STR TBS HMDVS 6 6 095206

Facility

$2,689.65

Hospital Charge Code	270630283
Hospital Revenue Code	278
Min. Negotiated Rate	$403.45
Max. Negotiated Rate	$1,344.83
Rate for Payer: Aetna Commercial	$806.89
Rate for Payer: Aetna Medicare Advantage	$806.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$685.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$685.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$685.86
Rate for Payer: Cigna Commercial	$1,344.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.90
Rate for Payer: Qualcare PPO/HMO/WC	$403.45

GRAFT STR TBS HMDVS 6 6 095206

Facility

$2,689.65

Hospital Charge Code	270630283
Hospital Revenue Code	278
Min. Negotiated Rate	$403.45
Max. Negotiated Rate	$650.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.90
Rate for Payer: Qualcare PPO/HMO/WC	$403.45

GRAFT SURGICAL 19x28cm XENMAT-

Facility

$103,989.87

Hospital Charge Code	270646489
Hospital Revenue Code	278
Min. Negotiated Rate	$15,598.48
Max. Negotiated Rate	$25,165.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,797.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,165.55
Rate for Payer: Qualcare PPO/HMO/WC	$15,598.48

GRAFT SURGICAL 19x28cm XENMAT-

Facility

$103,989.87

Hospital Charge Code	270646489
Hospital Revenue Code	278
Min. Negotiated Rate	$15,598.48
Max. Negotiated Rate	$51,994.93
Rate for Payer: Aetna Commercial	$31,196.96
Rate for Payer: Aetna Medicare Advantage	$31,196.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,517.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,517.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,797.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,517.42
Rate for Payer: Cigna Commercial	$51,994.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,165.55
Rate for Payer: Qualcare PPO/HMO/WC	$15,598.48

GRAFT SURGIS GLD HERNIA 276887

Facility

$4,630.00

Hospital Charge Code	270630129
Hospital Revenue Code	278
Min. Negotiated Rate	$694.50
Max. Negotiated Rate	$1,120.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$926.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,120.46
Rate for Payer: Qualcare PPO/HMO/WC	$694.50

GRAFT SURGIS GLD HERNIA 276887

Facility

$4,630.00

Hospital Charge Code	270630129
Hospital Revenue Code	278
Min. Negotiated Rate	$694.50
Max. Negotiated Rate	$2,315.00
Rate for Payer: Aetna Commercial	$1,389.00
Rate for Payer: Aetna Medicare Advantage	$1,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,180.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,180.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$926.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,180.65
Rate for Payer: Cigna Commercial	$2,315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,120.46
Rate for Payer: Qualcare PPO/HMO/WC	$694.50

GRAFT SV VASC 6 40 S40S06S

Facility

$2,252.85

Hospital Charge Code	270623939
Hospital Revenue Code	278
Min. Negotiated Rate	$337.93
Max. Negotiated Rate	$1,126.42
Rate for Payer: Aetna Commercial	$675.86
Rate for Payer: Aetna Medicare Advantage	$675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$574.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$574.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$574.48
Rate for Payer: Cigna Commercial	$1,126.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.19
Rate for Payer: Qualcare PPO/HMO/WC	$337.93

GRAFT SV VASC 6 40 S40S06S

Facility

$2,252.85

Hospital Charge Code	270623939
Hospital Revenue Code	278
Min. Negotiated Rate	$337.93
Max. Negotiated Rate	$545.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.19
Rate for Payer: Qualcare PPO/HMO/WC	$337.93

GRAFT SZR 4-7X40 S40ST0407S

Facility

$2,451.25

Hospital Charge Code	270626543
Hospital Revenue Code	278
Min. Negotiated Rate	$367.69
Max. Negotiated Rate	$593.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$593.20
Rate for Payer: Qualcare PPO/HMO/WC	$367.69

GRAFT SZR 4-7X40 S40ST0407S

Facility

$2,451.25

Hospital Charge Code	270626543
Hospital Revenue Code	278
Min. Negotiated Rate	$367.69
Max. Negotiated Rate	$1,225.62
Rate for Payer: Aetna Commercial	$735.38
Rate for Payer: Aetna Medicare Advantage	$735.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$625.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$625.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$625.07
Rate for Payer: Cigna Commercial	$1,225.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$593.20
Rate for Payer: Qualcare PPO/HMO/WC	$367.69

Know your out-of-pocket cost for care.

All Charges