Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENTGRAFTBEA28-60/I16-40AFX2

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061V
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

STENTGRAFTBEA28-60/I16-40AFX2

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061V
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$19,738.50
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

STENT GRAFT FLUENCY 10X40MM

Facility

$9,250.00

Hospital Charge Code	270669231
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

STENT GRAFT FLUENCY 10X40MM

Facility

$9,250.00

Hospital Charge Code	270669231
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$2,775.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

STENT GRAFT FLUENCY 6X60

Facility

$14,250.00

Hospital Charge Code	270639112
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STENT GRAFT FLUENCY 6X60

Facility

$14,250.00

Hospital Charge Code	270639112
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STENT GRAFT FLUENCY 8X40MM

Facility

$9,250.00

Hospital Charge Code	270669232
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

STENT GRAFT FLUENCY 8X40MM

Facility

$9,250.00

Hospital Charge Code	270669232
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$2,775.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

STENT GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894N
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 GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894N
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 GRAFT FLUENCY PLUS 8X60

Facility

$13,570.00

Hospital Charge Code	270937894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$3,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRAFT FLUENCY PLUS 8X60

Facility

$13,570.00

Hospital Charge Code	270937894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
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) NJ Health	$2,714.00
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	$3,283.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894C
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 GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894C
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 GRAFT FLY 10x60 FLT10060

Facility

$13,570.00

Hospital Charge Code	270634920V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
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) NJ Health	$2,714.00
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	$3,283.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRAFT FLY 10x60 FLT10060

Facility

$13,570.00

Hospital Charge Code	270634920V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$3,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,283.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

STENT GRAFT ILIAC EX 12mmX12mm

Facility

$23,495.00

Service Code	HCPCS C1763
Hospital Charge Code	270680927
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

STENT GRAFT ILIAC EX 12mmX12mm

Facility

$23,495.00

Service Code	HCPCS C1763
Hospital Charge Code	270680927
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$7,048.50
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

STENT GRAFT ILLIAC YRIRX15115

Facility

$12,028.00

Hospital Charge Code	270631398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,804.20
Max. Negotiated Rate	$6,014.00
Rate for Payer: Aetna Commercial	$3,608.40
Rate for Payer: Aetna Medicare Advantage	$3,608.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,067.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,067.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,405.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,067.14
Rate for Payer: Cigna Commercial	$6,014.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,910.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.20

STENT GRAFT ILLIAC YRIRX15115

Facility

$12,028.00

Hospital Charge Code	270631398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,804.20
Max. Negotiated Rate	$2,910.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,405.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,910.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.20

STENT GRAFT ILLIAC YRIRX1585

Facility

$11,036.00

Hospital Charge Code	270631399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$2,670.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

STENT GRAFT ILLIAC YRIRX1585

Facility

$11,036.00

Hospital Charge Code	270631399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$5,518.00
Rate for Payer: Aetna Commercial	$3,310.80
Rate for Payer: Aetna Medicare Advantage	$3,310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,814.18
Rate for Payer: Cigna Commercial	$5,518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

STENT GRAFT MASTER 2.8MMX16MM

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270691783
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFT MASTER 2.8MMX16MM

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270691783
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFTMASTER 2.8x19mm

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270668169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

Know your out-of-pocket cost for care.

All Charges