Heights University Hospital

All Charges

Charge

Type

Setting

Price

COILS STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587N
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$1,571.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 6MM X 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677679
Hospital Revenue Code	272
Min. Negotiated Rate	$844.35
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$844.35
Rate for Payer: Oxford Commercial	$3,247.50
Rate for Payer: Qualcare PPO/HMO/WC	$974.25
Rate for Payer: UnitedHealthcare Commercial	$3,247.50

COILS STD RUBY 6MM X 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677679N
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$1,571.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 6MM X 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677679
Hospital Revenue Code	272
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$974.25
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 6MM X 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677679N
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 9MM x 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677200N
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 9MM x 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677200
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$1,571.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 9MM x 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677200
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$1,948.50
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COILS STD RUBY 9MM x 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677200N
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$1,571.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COIL STANDARD RUBY 32MM X 60CM

Facility

$6,450.00

Hospital Charge Code	270687032C
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STANDARD RUBY 32MM X 60CM

Facility

$6,450.00

Hospital Charge Code	270687032C
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STANDARD RUBY 32MM X 60CM

Facility

$6,450.00

Hospital Charge Code	270687032
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STANDARD RUBY 32MM X 60CM

Facility

$6,450.00

Hospital Charge Code	270687032
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STD RUBY 4MM x 30CM

Facility

$6,450.00

Service Code	HCPCS C1884
Hospital Charge Code	270680571N
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STD RUBY 4MM x 30CM

Facility

$6,450.00

Service Code	HCPCS C1884
Hospital Charge Code	270680571N
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STD RUBY 4MM x 30CM

Facility

$6,450.00

Service Code	HCPCS C1884
Hospital Charge Code	270680571
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STD RUBY 4MM x 30CM

Facility

$6,450.00

Service Code	HCPCS C1884
Hospital Charge Code	270680571
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

COIL STD RUBY 5MM x 12CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270680572N
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL STD RUBY 5MM x 12CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270680572
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,485.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL STD RUBY 5MM x 12CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270680572
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL STD RUBY 5MM x 12CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270680572N
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,485.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL STN RUBY 4MMX10CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683219N
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL STN RUBY 4MMX10CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683219
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,485.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

Know your out-of-pocket cost for care.

All Charges