Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT 4.0X38 DES RSINT40038UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661698C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT 4.0X38 DES RSINT40038UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661698C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT 4.0X38 DES RSINT40038UX

Facility

$7,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270661698N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

STENT 4.0X38 DES RSINT40038UX

Facility

$7,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270661698N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,175.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

STENT 4.0X38 DES RSINT40038UX

Facility

$7,250.00

Hospital Charge Code	270661698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

STENT 4.0X38 DES RSINT40038UX

Facility

$7,250.00

Hospital Charge Code	270661698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,175.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

STENT 6X100X135 1012534-100

Facility

$5,250.00

Hospital Charge Code	270647812C
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT 6X100X135 1012534-100

Facility

$5,250.00

Hospital Charge Code	270647812C
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893N
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$508.50
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893S
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$508.50
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

STENT 6x120x120 PRB3506120120

Facility

$8,250.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893N
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$410.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893S
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$410.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

STENT 6x120x120 PRB3506120120

Facility

$8,250.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT 6 X 30 MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$3,050.00
Rate for Payer: Aetna Commercial	$1,830.00
Rate for Payer: Aetna Medicare Advantage	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,555.50
Rate for Payer: Cigna Commercial	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

STENT 6 X 30 MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,476.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

STENT 6X30MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517S
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$3,050.00
Rate for Payer: Aetna Commercial	$1,830.00
Rate for Payer: Aetna Medicare Advantage	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,555.50
Rate for Payer: Cigna Commercial	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

STENT 6X30MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517S
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,476.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

STENT 6x30x135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6x30x135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6X30X135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6X30X135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6x40x135 1012534-40

Facility

$4,750.00

Hospital Charge Code	270647806
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6x40x135 1012534-40

Facility

$4,750.00

Hospital Charge Code	270647806
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6X40X135 1012534-40

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647806C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

Know your out-of-pocket cost for care.

All Charges