Heights University Hospital

All Charges

Charge

Type

Setting

Price

COIL EMBOL OPTIMA 2MMX3CM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698130S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 2MMX3CM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698130S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$4,042.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 5CMX2.5MM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698129S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$4,042.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 5CMX2.5MM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698129S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL LP DETACHMENT RLPH1

Facility

$1,190.00

Hospital Charge Code	270696371C
Hospital Revenue Code	272
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$595.00
Rate for Payer: Aetna Commercial	$357.00
Rate for Payer: Aetna Medicare Advantage	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.45
Rate for Payer: Cigna Commercial	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.70
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$178.50
Rate for Payer: UnitedHealthcare Commercial	$595.00

COIL LP DETACHMENT RLPH1

Facility

$1,190.00

Hospital Charge Code	270696371C
Hospital Revenue Code	272
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$178.50
Rate for Payer: Qualcare PPO/HMO/WC	$178.50

COIL MICRO 3/2 2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270627360N
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRO 3/2 2CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270627360
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$133.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: Qualcare PPO/HMO/WC	$82.60

COIL MICRO 3/2 2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270627360N
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRO 3/2 2CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270627360
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$275.32
Rate for Payer: Aetna Commercial	$165.19
Rate for Payer: Aetna Medicare Advantage	$165.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.42
Rate for Payer: Cigna Commercial	$275.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: Qualcare PPO/HMO/WC	$82.60

COIL MICRONESTER 10mm

Facility

$480.00

Hospital Charge Code	270629642
Hospital Revenue Code	271
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$240.00

COIL MICRONESTER 10mm

Facility

$480.00

Hospital Charge Code	270629642
Hospital Revenue Code	271
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRONESTER 3MM

Facility

$255.00

Hospital Charge Code	270629637
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

COIL MICRONESTER 3MM

Facility

$255.00

Hospital Charge Code	270629637
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

COIL MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637V
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRONESTER 3MM G26987

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629637C
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$127.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637N
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRONESTER 3MM G26987

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629637C
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$264.20
Rate for Payer: Aetna Commercial	$158.52
Rate for Payer: Aetna Medicare Advantage	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.74
Rate for Payer: Cigna Commercial	$264.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637N
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637V
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRONESTER 4mm

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629638
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$127.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL MICRONESTER 4mm

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629638
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$264.20
Rate for Payer: Aetna Commercial	$158.52
Rate for Payer: Aetna Medicare Advantage	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.74
Rate for Payer: Cigna Commercial	$264.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL MICRONESTER 4MM G26988

Facility

$480.00

Hospital Charge Code	270629638C
Hospital Revenue Code	272
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$240.00

COIL MICRONESTER 4MM G26988

Facility

$480.00

Hospital Charge Code	270629638C
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL MICRONESTER 6MM G26989

Facility

$480.00

Hospital Charge Code	270629641C
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

Know your out-of-pocket cost for care.

All Charges