Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT VIABAHN 7X5X120MM

Facility

$17,185.00

Service Code	HCPCS C1768
Hospital Charge Code	270680178S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,577.75
Max. Negotiated Rate	$8,592.50
Rate for Payer: Aetna Commercial	$5,155.50
Rate for Payer: Aetna Medicare Advantage	$5,155.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,382.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,382.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,437.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,382.18
Rate for Payer: Cigna Commercial	$8,592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,158.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,577.75

GRAFT VIABAHN 7X5X120MM

Facility

$17,185.00

Service Code	HCPCS C1768
Hospital Charge Code	270680178S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,577.75
Max. Negotiated Rate	$4,158.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,158.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,577.75

GRAFT VIABAHN 8MM 5CM LOW PROF

Facility

$17,615.00

Service Code	HCPCS C1768
Hospital Charge Code	270648642
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$5,284.50
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

GRAFT VIABAHN 8MM 5CM LOW PROF

Facility

$17,615.00

Service Code	HCPCS C1768
Hospital Charge Code	270648642
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

GRAFT VIABAHN 8mmx15cm 120cm

Facility

$21,475.00

Service Code	HCPCS C1768
Hospital Charge Code	270678588
Hospital Revenue Code	278
Min. Negotiated Rate	$3,221.25
Max. Negotiated Rate	$5,196.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,196.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,221.25

GRAFT VIABAHN 8mmx15cm 120cm

Facility

$21,475.00

Service Code	HCPCS C1768
Hospital Charge Code	270678588
Hospital Revenue Code	278
Min. Negotiated Rate	$3,221.25
Max. Negotiated Rate	$10,737.50
Rate for Payer: Aetna Commercial	$6,442.50
Rate for Payer: Aetna Medicare Advantage	$6,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,476.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,476.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,476.12
Rate for Payer: Cigna Commercial	$10,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,196.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,221.25

GRAFT VIABAHN ENDOPROSTHESIS

Facility

$10,650.00

Hospital Charge Code	270658082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,597.50
Max. Negotiated Rate	$2,577.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,577.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,597.50

GRAFT VIABAHN ENDOPROSTHESIS

Facility

$10,650.00

Hospital Charge Code	270658082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,597.50
Max. Negotiated Rate	$5,325.00
Rate for Payer: Aetna Commercial	$3,195.00
Rate for Payer: Aetna Medicare Advantage	$3,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,715.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,715.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,715.75
Rate for Payer: Cigna Commercial	$5,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,577.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,597.50

GRAFT VIATR ENDOPROS PTA108275

Facility

$14,741.20

Hospital Charge Code	270634874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,211.18
Max. Negotiated Rate	$3,567.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,948.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,567.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,211.18

GRAFT VIATR ENDOPROS PTA108275

Facility

$14,741.20

Hospital Charge Code	270634874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,211.18
Max. Negotiated Rate	$7,370.60
Rate for Payer: Aetna Commercial	$4,422.36
Rate for Payer: Aetna Medicare Advantage	$4,422.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,759.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,759.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,948.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,759.01
Rate for Payer: Cigna Commercial	$7,370.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,567.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,211.18

GRAFT VIATR ENDOPROS PTA108275

Facility

$14,741.20

Hospital Charge Code	270634874v
Hospital Revenue Code	278
Min. Negotiated Rate	$2,211.18
Max. Negotiated Rate	$3,567.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,948.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,567.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,211.18

GRAFT VIATR ENDOPROS PTA108275

Facility

$14,741.20

Hospital Charge Code	270634874v
Hospital Revenue Code	278
Min. Negotiated Rate	$2,211.18
Max. Negotiated Rate	$7,370.60
Rate for Payer: Aetna Commercial	$4,422.36
Rate for Payer: Aetna Medicare Advantage	$4,422.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,759.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,759.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,948.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,759.01
Rate for Payer: Cigna Commercial	$7,370.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,567.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,211.18

GRAFT VIVIGEN 10 CC CRYO

Facility

$23,535.00

Service Code	HCPCS C1762
Hospital Charge Code	270686039
Hospital Revenue Code	278
Min. Negotiated Rate	$3,530.25
Max. Negotiated Rate	$5,695.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,707.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,695.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25

GRAFT VIVIGEN 10 CC CRYO

Facility

$23,535.00

Service Code	HCPCS C1762
Hospital Charge Code	270686039
Hospital Revenue Code	278
Min. Negotiated Rate	$3,530.25
Max. Negotiated Rate	$11,767.50
Rate for Payer: Aetna Commercial	$7,060.50
Rate for Payer: Aetna Medicare Advantage	$7,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,707.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,001.43
Rate for Payer: Cigna Commercial	$11,767.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,695.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25

GRAFT VIVIGEN 15CC CRYO

Facility

$28,980.00

Service Code	HCPCS C1762
Hospital Charge Code	270686040
Hospital Revenue Code	278
Min. Negotiated Rate	$4,347.00
Max. Negotiated Rate	$14,490.00
Rate for Payer: Aetna Commercial	$8,694.00
Rate for Payer: Aetna Medicare Advantage	$8,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,389.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,389.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,389.90
Rate for Payer: Cigna Commercial	$14,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,013.16
Rate for Payer: Qualcare PPO/HMO/WC	$4,347.00

GRAFT VIVIGEN 15CC CRYO

Facility

$28,980.00

Service Code	HCPCS C1762
Hospital Charge Code	270686040
Hospital Revenue Code	278
Min. Negotiated Rate	$4,347.00
Max. Negotiated Rate	$7,013.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,796.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,013.16
Rate for Payer: Qualcare PPO/HMO/WC	$4,347.00

GRAFT VIVIGEN 5CC CRYO

Facility

$13,020.00

Service Code	HCPCS C1762
Hospital Charge Code	270686038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$3,150.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00

GRAFT VIVIGEN 5CC CRYO

Facility

$13,020.00

Service Code	HCPCS C1762
Hospital Charge Code	270686038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$6,510.00
Rate for Payer: Aetna Commercial	$3,906.00
Rate for Payer: Aetna Medicare Advantage	$3,906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,320.10
Rate for Payer: Cigna Commercial	$6,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00

GRAFT VIVIGEN BONE MATRIX 10CC

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673359
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$11,625.00
Rate for Payer: Aetna Commercial	$6,975.00
Rate for Payer: Aetna Medicare Advantage	$6,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,928.75
Rate for Payer: Cigna Commercial	$11,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

GRAFT VIVIGEN BONE MATRIX 10CC

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673359
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

GRAFT WOUND MATRIX 5 X 5 CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696692
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT WOUND MATRIX 5 X 5 CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696692
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,903.50
Rate for Payer: Aetna Commercial	$1,903.50
Rate for Payer: Aetna Medicare Advantage	$1,903.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,617.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,617.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,617.97
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT WOUND MATRIX 5X5CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696726
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,903.50
Rate for Payer: Aetna Commercial	$1,903.50
Rate for Payer: Aetna Medicare Advantage	$1,903.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,617.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,617.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,617.97
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT WOUND MATRIX 5X5CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696726
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT XENMATRIX AB 4 X 8 CM

Facility

$30,300.00

Service Code	HCPCS C1781
Hospital Charge Code	270684825
Hospital Revenue Code	278
Min. Negotiated Rate	$4,545.00
Max. Negotiated Rate	$7,332.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,545.00

Know your out-of-pocket cost for care.

All Charges