Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998S
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GPS 12MMx60MM, 80CM

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270636999
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$1,987.44
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT GPS 12MMx60MM, 80CM

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270636999
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT GPS 14MMx30MM, 120CM

Facility

$4,500.00

Hospital Charge Code	270643090
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GPS 14MMx30MM, 120CM

Facility

$4,500.00

Hospital Charge Code	270643090
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GPS 9MMx40MM, 80CM

Facility

$4,500.00

Hospital Charge Code	270637012
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GPS 9MMx40MM, 80CM

Facility

$4,500.00

Hospital Charge Code	270637012
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT GRAFT 10FR 11MM X 10CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692118
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$10,225.00
Rate for Payer: Aetna Commercial	$6,135.00
Rate for Payer: Aetna Medicare Advantage	$6,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,214.75
Rate for Payer: Cigna Commercial	$10,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 10FR 11MM X 10CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692118
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$4,948.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 10FR 13MM X 10 CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692120
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$10,225.00
Rate for Payer: Aetna Commercial	$6,135.00
Rate for Payer: Aetna Medicare Advantage	$6,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,214.75
Rate for Payer: Cigna Commercial	$10,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 10FR 13MM X 10 CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692120
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$4,948.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 20-13x88

Facility

$17,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270672011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,624.25
Max. Negotiated Rate	$4,233.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,233.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,624.25

STENT GRAFT 20-13x88

Facility

$17,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270672011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,624.25
Max. Negotiated Rate	$8,747.50
Rate for Payer: Aetna Commercial	$5,248.50
Rate for Payer: Aetna Medicare Advantage	$5,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,461.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,461.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,461.23
Rate for Payer: Cigna Commercial	$8,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,233.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,624.25

STENT GRAFT AORTIC YRECX26375

Facility

$10,044.00

Hospital Charge Code	270631401
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.60
Max. Negotiated Rate	$5,022.00
Rate for Payer: Aetna Commercial	$3,013.20
Rate for Payer: Aetna Medicare Advantage	$3,013.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,561.22
Rate for Payer: Cigna Commercial	$5,022.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60

STENT GRAFT AORTIC YRECX26375

Facility

$10,044.00

Hospital Charge Code	270631401
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.60
Max. Negotiated Rate	$2,430.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60

STENT GRAFT AORTIC YRECX28375

Facility

$10,044.00

Hospital Charge Code	270629599
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.60
Max. Negotiated Rate	$2,430.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60

STENT GRAFT AORTIC YRECX28375

Facility

$10,044.00

Hospital Charge Code	270629599
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.60
Max. Negotiated Rate	$5,022.00
Rate for Payer: Aetna Commercial	$3,013.20
Rate for Payer: Aetna Medicare Advantage	$3,013.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,561.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,008.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,561.22
Rate for Payer: Cigna Commercial	$5,022.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,430.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,506.60

STENT GRAFT BA22-80/120-40

Facility

$57,900.00

Hospital Charge Code	270659187C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STENT GRAFT BA22-80/120-40

Facility

$57,900.00

Hospital Charge Code	270659187C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STENT GRAFT BA25-110/120-30

Facility

$57,900.00

Hospital Charge Code	270659157C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STENT GRAFT BA25-110/120-30

Facility

$57,900.00

Hospital Charge Code	270659157C
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$17,370.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

STENT GRAFT BALLOOM Q50X

Facility

$4,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270689534
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

STENT GRAFT BALLOOM Q50X

Facility

$4,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270689534
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

Know your out-of-pocket cost for care.

All Charges