Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT ADVANIX BILIARY 7F 9CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663631
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX BILIARY 7F 9CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663631
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$201.00
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX BILIARY 7FR 5CM

Facility

$651.90

Service Code	HCPCS C2625
Hospital Charge Code	270675166
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$195.57
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT ADVANIX BILIARY 7FR 5CM

Facility

$651.90

Service Code	HCPCS C2625
Hospital Charge Code	270675166
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT ADVANIX BILIARY 7FR 7CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270675167
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX BILIARY 7FR 7CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270675167
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$201.00
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX BILIARY 7FR 9CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270675168
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX BILIARY 7FR 9CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270675168
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$201.00
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX DBL PGTL 7FR 3CM

Facility

$262.75

Service Code	HCPCS C2625
Hospital Charge Code	270675171
Hospital Revenue Code	278
Min. Negotiated Rate	$39.41
Max. Negotiated Rate	$63.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.59
Rate for Payer: Qualcare PPO/HMO/WC	$39.41

STENT ADVANIX DBL PGTL 7FR 3CM

Facility

$262.75

Service Code	HCPCS C2625
Hospital Charge Code	270675171
Hospital Revenue Code	278
Min. Negotiated Rate	$39.41
Max. Negotiated Rate	$131.38
Rate for Payer: Aetna Commercial	$78.83
Rate for Payer: Aetna Medicare Advantage	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.00
Rate for Payer: Cigna Commercial	$131.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.59
Rate for Payer: Qualcare PPO/HMO/WC	$39.41

STENT ADVANIX PANC KIT 4FR 4CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270675174
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANC KIT 4FR 4CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270675174
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANCR 7FR 12CM

Facility

$435.00

Service Code	HCPCS C2625
Hospital Charge Code	270677862
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$130.50
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

STENT ADVANIX PANCR 7FR 12CM

Facility

$435.00

Service Code	HCPCS C2625
Hospital Charge Code	270677862
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$105.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

STENT ADVANIX PANCREAT 4FR 3CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270675173
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANCREAT 4FR 3CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270675173
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70

STENT ADVANIX PANCREAT 4FR 5CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270677788
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANCREAT 4FR 5CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270677788
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANCREAT 4FR 7CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270677789
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANCREAT 4FR 7CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270677789
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

Know your out-of-pocket cost for care.

All Charges