Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT ADVANIX PANC STR 4FR 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168
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 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168
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	$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 5FR 4CM

Facility

$385.00

Service Code	HCPCS C2617
Hospital Charge Code	270677006
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$115.50
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

STENT ADVANIX PANC STR 5FR 4CM

Facility

$385.00

Service Code	HCPCS C2617
Hospital Charge Code	270677006
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

STENT ADVANIX PUSHER 4&5FRSTEN

Facility

$245.75

Hospital Charge Code	270676451
Hospital Revenue Code	272
Min. Negotiated Rate	$36.86
Max. Negotiated Rate	$36.86
Rate for Payer: Qualcare PPO/HMO/WC	$36.86

STENT ADVANIX PUSHER 4&5FRSTEN

Facility

$245.75

Hospital Charge Code	270676451
Hospital Revenue Code	272
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$122.88
Rate for Payer: Aetna Commercial	$73.72
Rate for Payer: Aetna Medicare Advantage	$73.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.67
Rate for Payer: Cigna Commercial	$122.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.95
Rate for Payer: Oxford Commercial	$122.88
Rate for Payer: Qualcare PPO/HMO/WC	$36.86
Rate for Payer: UnitedHealthcare Commercial	$122.88

STENT ADVANTIX PANCRE 10FR 5cm

Facility

$435.00

Hospital Charge Code	270675434
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 ADVANTIX PANCRE 10FR 5cm

Facility

$435.00

Hospital Charge Code	270675434
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 ADVANTIX PANCRE 10FR 7cm

Facility

$435.00

Hospital Charge Code	270675435
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 ADVANTIX PANCRE 10FR 7cm

Facility

$435.00

Hospital Charge Code	270675435
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 ADVANTIX PANCRE 10FR 9cm

Facility

$435.00

Hospital Charge Code	270675436
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 ADVANTIX PANCRE 10FR 9cm

Facility

$435.00

Hospital Charge Code	270675436
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 ANCILLARY COVER

Facility

$35,590.00

Hospital Charge Code	270686467
Hospital Revenue Code	272
Min. Negotiated Rate	$5,338.50
Max. Negotiated Rate	$5,338.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,338.50

STENT ANCILLARY COVER

Facility

$35,590.00

Hospital Charge Code	270686467
Hospital Revenue Code	272
Min. Negotiated Rate	$4,626.70
Max. Negotiated Rate	$17,795.00
Rate for Payer: Aetna Commercial	$10,677.00
Rate for Payer: Aetna Medicare Advantage	$10,677.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,075.45
Rate for Payer: Cigna Commercial	$17,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,626.70
Rate for Payer: Oxford Commercial	$17,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,338.50
Rate for Payer: UnitedHealthcare Commercial	$17,795.00

STENT ANTIREFLUX 10x5 FSMAR105

Facility

$1,100.00

Hospital Charge Code	270641702
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$330.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

STENT ANTIREFLUX 10x5 FSMAR105

Facility

$1,100.00

Hospital Charge Code	270641702
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$266.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

STENT ANTIREFLUX 10X7 FSMAR107

Facility

$1,140.00

Hospital Charge Code	270641703
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT ANTIREFLUX 10X7 FSMAR107

Facility

$1,140.00

Hospital Charge Code	270641703
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STEN TAX EXP 2.5x16m 389681625

Facility

$13,625.00

Hospital Charge Code	270637307C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 2.5x16m 389681625

Facility

$13,625.00

Hospital Charge Code	270637307C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 3.5x12m 389681235

Facility

$13,625.00

Hospital Charge Code	270637309C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 3.5x12m 389681235

Facility

$13,625.00

Hospital Charge Code	270637309C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 3.5x16m 389681635

Facility

$13,625.00

Hospital Charge Code	270637305C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STEN TAX EXP 3.5x16m 389681635

Facility

$13,625.00

Hospital Charge Code	270637305C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

Know your out-of-pocket cost for care.

All Charges