Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT FG, PROMUS ELEMENT PLUS

Facility

$8,750.00

Hospital Charge Code	270CH0077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT FG PROMUS ELEMENT PLUS 2

Facility

$8,750.00

Hospital Charge Code	270665003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT FG PROMUS ELEMENT PLUS 2

Facility

$8,750.00

Hospital Charge Code	270665003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$144.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667N
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$179.40
Rate for Payer: Aetna Medicare Advantage	$179.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.49
Rate for Payer: Cigna Commercial	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667N
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$144.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$179.40
Rate for Payer: Aetna Medicare Advantage	$179.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.49
Rate for Payer: Cigna Commercial	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667S
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$144.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667S
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$179.40
Rate for Payer: Aetna Medicare Advantage	$179.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.49
Rate for Payer: Cigna Commercial	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633N
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$285.82
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633S
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633N
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633S
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$285.82
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$285.82
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLUENCY PLUS 10x60

Facility

$2,714.00

Hospital Charge Code	270634920
Hospital Revenue Code	278
Min. Negotiated Rate	$407.10
Max. Negotiated Rate	$1,357.00
Rate for Payer: Aetna Commercial	$814.20
Rate for Payer: Aetna Medicare Advantage	$814.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.07
Rate for Payer: Cigna Commercial	$1,357.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.79
Rate for Payer: Qualcare PPO/HMO/WC	$407.10

STENT FLUENCY PLUS 10x60

Facility

$2,714.00

Hospital Charge Code	270634920
Hospital Revenue Code	278
Min. Negotiated Rate	$407.10
Max. Negotiated Rate	$656.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$542.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$656.79
Rate for Payer: Qualcare PPO/HMO/WC	$407.10

STENT FLUENCY PLUS 10X60

Facility

$13,570.00

Hospital Charge Code	2709003570
Hospital Revenue Code	272
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT FLUENCY PLUS 10X60

Facility

$13,570.00

Hospital Charge Code	2709003570
Hospital Revenue Code	272
Min. Negotiated Rate	$1,764.10
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,785.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,785.00

STENT FLUENCY PLUS 8 X 60 X 8

Facility

$15,715.00

Service Code	HCPCS C1874
Hospital Charge Code	270637894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8 X 60 X 8

Facility

$15,715.00

Service Code	HCPCS C1874
Hospital Charge Code	270637894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$4,714.50
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8 X 60 X 80

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8 X 60 X 80

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$4,714.50
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8X60X80

Facility

$13,570.00

Hospital Charge Code	2709003571
Hospital Revenue Code	272
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT FLUENCY PLUS 8X60X80

Facility

$13,570.00

Hospital Charge Code	2709003571
Hospital Revenue Code	272
Min. Negotiated Rate	$1,764.10
Max. Negotiated Rate	$6,785.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,785.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,785.00

Know your out-of-pocket cost for care.

All Charges