Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT AXIOS SYSTEM 10x10MM

Facility

$24,650.00

Service Code	HCPCS C1874
Hospital Charge Code	270677310
Hospital Revenue Code	278
Min. Negotiated Rate	$3,697.50
Max. Negotiated Rate	$5,965.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,965.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,697.50

STENT AXIOS SYSTEM 10x10MM

Facility

$24,650.00

Service Code	HCPCS C1874
Hospital Charge Code	270677310
Hospital Revenue Code	278
Min. Negotiated Rate	$3,697.50
Max. Negotiated Rate	$12,325.00
Rate for Payer: Aetna Commercial	$7,395.00
Rate for Payer: Aetna Medicare Advantage	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,285.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,285.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,285.75
Rate for Payer: Cigna Commercial	$12,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,965.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,697.50

STENT AXIOS SYSTEM 15x10MM

Facility

$22,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270677311
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

STENT AXIOS SYSTEM 15x10MM

Facility

$22,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270677311
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$6,600.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

STENT AXIOS SYSTEM 15 X 15MM

Facility

$24,977.50

Service Code	HCPCS C1874
Hospital Charge Code	270693213
Hospital Revenue Code	278
Min. Negotiated Rate	$3,746.62
Max. Negotiated Rate	$12,488.75
Rate for Payer: Aetna Commercial	$7,493.25
Rate for Payer: Aetna Medicare Advantage	$7,493.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,369.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,369.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,369.26
Rate for Payer: Cigna Commercial	$12,488.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,044.56
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.62

STENT AXIOS SYSTEM 15 X 15MM

Facility

$24,977.50

Service Code	HCPCS C1874
Hospital Charge Code	270693213
Hospital Revenue Code	278
Min. Negotiated Rate	$3,746.62
Max. Negotiated Rate	$6,044.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,044.56
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.62

STENT BALLOON AORTIC 65MM

Facility

$3,995.00

Service Code	HCPCS C1725
Hospital Charge Code	270697993C
Hospital Revenue Code	278
Min. Negotiated Rate	$599.25
Max. Negotiated Rate	$1,997.50
Rate for Payer: Aetna Commercial	$1,198.50
Rate for Payer: Aetna Medicare Advantage	$1,198.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,018.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,018.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,018.73
Rate for Payer: Cigna Commercial	$1,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.79
Rate for Payer: Qualcare PPO/HMO/WC	$599.25

STENT BALLOON AORTIC 65MM

Facility

$3,995.00

Service Code	HCPCS C1725
Hospital Charge Code	270697993C
Hospital Revenue Code	278
Min. Negotiated Rate	$599.25
Max. Negotiated Rate	$966.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.79
Rate for Payer: Qualcare PPO/HMO/WC	$599.25

STENT BILIARY 10-5 SET

Facility

$785.00

Hospital Charge Code	270652849
Hospital Revenue Code	278
Min. Negotiated Rate	$117.75
Max. Negotiated Rate	$392.50
Rate for Payer: Aetna Commercial	$235.50
Rate for Payer: Aetna Medicare Advantage	$235.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.18
Rate for Payer: Cigna Commercial	$392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.97
Rate for Payer: Qualcare PPO/HMO/WC	$117.75

STENT BILIARY 10-5 SET

Facility

$785.00

Hospital Charge Code	270652849
Hospital Revenue Code	278
Min. Negotiated Rate	$117.75
Max. Negotiated Rate	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.97
Rate for Payer: Qualcare PPO/HMO/WC	$117.75

STENT BILIARY 10FR X 12CM 4563

Facility

$580.40

Hospital Charge Code	270630047
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$140.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT BILIARY 10FR X 12CM 4563

Facility

$580.40

Hospital Charge Code	270630047
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$290.20
Rate for Payer: Aetna Commercial	$174.12
Rate for Payer: Aetna Medicare Advantage	$174.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.00
Rate for Payer: Cigna Commercial	$290.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT BILIARY 8 5Fx10cm 4567

Facility

$580.40

Hospital Charge Code	270628071
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$290.20
Rate for Payer: Aetna Commercial	$174.12
Rate for Payer: Aetna Medicare Advantage	$174.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.00
Rate for Payer: Cigna Commercial	$290.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT BILIARY 8 5Fx10cm 4567

Facility

$580.40

Hospital Charge Code	270628071
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$140.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT BILIARY COTTON CLBS-07-5

Facility

$1,032.85

Hospital Charge Code	270600992
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$249.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.95
Rate for Payer: Qualcare PPO/HMO/WC	$154.93

STENT BILIARY COTTON CLBS-07-5

Facility

$1,032.85

Hospital Charge Code	270600992
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$516.42
Rate for Payer: Aetna Commercial	$309.86
Rate for Payer: Aetna Medicare Advantage	$309.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.38
Rate for Payer: Cigna Commercial	$516.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.95
Rate for Payer: Qualcare PPO/HMO/WC	$154.93

STENT BILIARY COTTON CLBS-07-7

Facility

$971.25

Hospital Charge Code	270600973
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$485.62
Rate for Payer: Aetna Commercial	$291.38
Rate for Payer: Aetna Medicare Advantage	$291.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.67
Rate for Payer: Cigna Commercial	$485.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.04
Rate for Payer: Qualcare PPO/HMO/WC	$145.69

STENT BILIARY COTTON CLBS-07-7

Facility

$971.25

Hospital Charge Code	270600973
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$235.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.04
Rate for Payer: Qualcare PPO/HMO/WC	$145.69

STENT BILIARY COTTON CLBS-07-9

Facility

$1,032.85

Hospital Charge Code	270607996
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$516.42
Rate for Payer: Aetna Commercial	$309.86
Rate for Payer: Aetna Medicare Advantage	$309.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.38
Rate for Payer: Cigna Commercial	$516.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.95
Rate for Payer: Qualcare PPO/HMO/WC	$154.93

STENT BILIARY COTTON CLBS-07-9

Facility

$1,032.85

Hospital Charge Code	270607996
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$249.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.95
Rate for Payer: Qualcare PPO/HMO/WC	$154.93

STENT BILIARY COTTON CLBS-1010

Facility

$1,021.65

Hospital Charge Code	270609566
Hospital Revenue Code	278
Min. Negotiated Rate	$153.25
Max. Negotiated Rate	$510.82
Rate for Payer: Aetna Commercial	$306.50
Rate for Payer: Aetna Medicare Advantage	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.52
Rate for Payer: Cigna Commercial	$510.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.24
Rate for Payer: Qualcare PPO/HMO/WC	$153.25

STENT BILIARY COTTON CLBS-1010

Facility

$1,021.65

Hospital Charge Code	270609566
Hospital Revenue Code	278
Min. Negotiated Rate	$153.25
Max. Negotiated Rate	$247.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.24
Rate for Payer: Qualcare PPO/HMO/WC	$153.25

STENT BILIARY COTTON CLBS-1012

Facility

$929.65

Hospital Charge Code	270609868
Hospital Revenue Code	278
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$464.82
Rate for Payer: Aetna Commercial	$278.89
Rate for Payer: Aetna Medicare Advantage	$278.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.06
Rate for Payer: Cigna Commercial	$464.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.98
Rate for Payer: Qualcare PPO/HMO/WC	$139.45

STENT BILIARY COTTON CLBS-1012

Facility

$929.65

Hospital Charge Code	270609868
Hospital Revenue Code	278
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$224.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.98
Rate for Payer: Qualcare PPO/HMO/WC	$139.45

STENT BILIARY COTTON CLBS-10-5

Facility

$1,032.85

Hospital Charge Code	270600989
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$516.42
Rate for Payer: Aetna Commercial	$309.86
Rate for Payer: Aetna Medicare Advantage	$309.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.38
Rate for Payer: Cigna Commercial	$516.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.95
Rate for Payer: Qualcare PPO/HMO/WC	$154.93

Know your out-of-pocket cost for care.

All Charges