Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT DOUBLE PIG 7F 2.3MMx7CM

Facility

$266.50

Service Code	HCPCS C2617
Hospital Charge Code	270672793
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DOUBLE PIG 7F 2.3MMx7CM

Facility

$266.50

Service Code	HCPCS C2617
Hospital Charge Code	270672793
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$79.95
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DOUBLE PIGTAIL 7FR X 5CM

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270665764
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT DOUBLE PIGTAIL 7FR X 5CM

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270665764
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT DOUBLE PIGTAIL 7FR X 7cm

Facility

$295.00

Hospital Charge Code	270653628
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT DOUBLE PIGTAIL 7FR X 7cm

Facility

$295.00

Hospital Charge Code	270653628
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT DOUBLE PIGTAIL SZ 10-5

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270673460
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT DOUBLE PIGTAIL SZ 10-5

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270673460
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT DOUBLE PIGTAIL SZ 7-10

Facility

$266.50

Hospital Charge Code	270673443
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DOUBLE PIGTAIL SZ 7-10

Facility

$266.50

Hospital Charge Code	270673443
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$79.95
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DOUBLE PIGTAIL SZ 7-5

Facility

$266.50

Hospital Charge Code	270673442
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DOUBLE PIGTAIL SZ 7-5

Facility

$266.50

Hospital Charge Code	270673442
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$79.95
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Hospital Charge Code	2700909
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Hospital Charge Code	2700909
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25 /9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25/9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG ELUTING 2.25/9 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700909S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DRUG-ELUT PERIPH 6x100MM

Facility

$8,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270675417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$2,692.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT DRUG-ELUT PERIPH 6x100MM

Facility

$8,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270675417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT DRUG-ELUT PERIPH 6x40MM

Facility

$5,875.00

Hospital Charge Code	270675419
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$1,762.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

STENT DRUG-ELUT PERIPH 6x40MM

Facility

$5,875.00

Hospital Charge Code	270675419
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

STENT DRUG-ELUT PERIPH 6x60MM

Facility

$7,475.00

Service Code	HCPCS C1874
Hospital Charge Code	270675418
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 DRUG-ELUT PERIPH 6x60MM

Facility

$7,475.00

Service Code	HCPCS C1874
Hospital Charge Code	270675418
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 DRUG-ELUT PERIPH 6x80MM

Facility

$8,975.00

Hospital Charge Code	270667654
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$2,692.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

Know your out-of-pocket cost for care.

All Charges