Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT BILIARY ZEM 7F ZEBD-7-12

Facility

$440.00

Hospital Charge Code	270625568
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

STENT BILIARY ZEM 7F ZEBD-7-12

Facility

$440.00

Hospital Charge Code	270625568
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$132.00
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

STENT BILIARY ZIMMON ZEBD-7-4

Facility

$685.00

Service Code	HCPCS C2617
Hospital Charge Code	270609869
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILIARY ZIMMON ZEBD-7-4

Facility

$685.00

Service Code	HCPCS C2617
Hospital Charge Code	270609869
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$205.50
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILIARY ZIMMON ZEBD-7-7

Facility

$685.00

Service Code	HCPCS C2625
Hospital Charge Code	270600972
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILIARY ZIMMON ZEBD-7-7

Facility

$685.00

Service Code	HCPCS C2625
Hospital Charge Code	270600972
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$205.50
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILLARY ADVANIX 10X7

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663474
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 BILLARY ADVANIX 10X7

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663474
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 BIL PL 7x18x80 PB1870BSS

Facility

$7,167.25

Hospital Charge Code	270635362
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.09
Max. Negotiated Rate	$3,583.62
Rate for Payer: Aetna Commercial	$2,150.18
Rate for Payer: Aetna Medicare Advantage	$2,150.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,827.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,827.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,433.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,827.65
Rate for Payer: Cigna Commercial	$3,583.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.09

STENT BIL PL 7x18x80 PB1870BSS

Facility

$7,167.25

Hospital Charge Code	270635362V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.09
Max. Negotiated Rate	$3,583.62
Rate for Payer: Aetna Commercial	$2,150.18
Rate for Payer: Aetna Medicare Advantage	$2,150.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,827.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,827.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,433.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,827.65
Rate for Payer: Cigna Commercial	$3,583.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.09

STENT BIL PL 7x18x80 PB1870BSS

Facility

$7,167.25

Hospital Charge Code	270635362
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.09
Max. Negotiated Rate	$1,734.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,433.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.09

STENT BIL PL 7x18x80 PB1870BSS

Facility

$7,167.25

Hospital Charge Code	270635362V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.09
Max. Negotiated Rate	$1,734.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,433.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.09

STENT BIL SENT 8x81 38948-8807

Facility

$7,475.00

Hospital Charge Code	270638511V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

STENT BIL SENT 8x81 38948-8807

Facility

$7,475.00

Hospital Charge Code	270638511V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

STENT BIOMIM 3D SWIR FLW 5x100

Facility

$5,750.00

Hospital Charge Code	270705366
Hospital Revenue Code	279
Min. Negotiated Rate	$747.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.50
Rate for Payer: Oxford Commercial	$2,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$2,875.00

STENT BIOMIM 3D SWIR FLW 5x100

Facility

$5,750.00

Hospital Charge Code	270705366
Hospital Revenue Code	279
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

STENT BIOMIM 3D SWIR FLW 5x125

Facility

$575.00

Hospital Charge Code	270705367
Hospital Revenue Code	279
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Oxford Commercial	$287.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Commercial	$287.50

STENT BIOMIM 3D SWIR FLW 5x125

Facility

$575.00

Hospital Charge Code	270705367
Hospital Revenue Code	279
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

STENT BIOMIM 3D SWIR FLW 5x150

Facility

$5,750.00

Hospital Charge Code	270705368
Hospital Revenue Code	279
Min. Negotiated Rate	$747.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.50
Rate for Payer: Oxford Commercial	$2,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$2,875.00

STENT BIOMIM 3D SWIR FLW 5x150

Facility

$5,750.00

Hospital Charge Code	270705368
Hospital Revenue Code	279
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

STENT BIOMIM 3D SWIR FLW 5x60

Facility

$5,250.00

Hospital Charge Code	270705369
Hospital Revenue Code	279
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT BIOMIM 3D SWIR FLW 5x60

Facility

$5,250.00

Hospital Charge Code	270705369
Hospital Revenue Code	279
Min. Negotiated Rate	$682.50
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) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$2,625.00

STENT BIOMIM 3D SWIR FLW 6x100

Facility

$5,750.00

Hospital Charge Code	270705370
Hospital Revenue Code	279
Min. Negotiated Rate	$747.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.50
Rate for Payer: Oxford Commercial	$2,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$2,875.00

STENT BIOMIM 3D SWIR FLW 6x100

Facility

$5,750.00

Hospital Charge Code	270705370
Hospital Revenue Code	279
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

STENT BIOMIM 3D SWIR FLW 6x125

Facility

$5,750.00

Hospital Charge Code	270705371
Hospital Revenue Code	279
Min. Negotiated Rate	$747.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.50
Rate for Payer: Oxford Commercial	$2,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$2,875.00

Know your out-of-pocket cost for care.

All Charges