Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$3,862.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$3,862.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT ILIAC LEG G55245

Facility

$15,425.00

Hospital Charge Code	270647930C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,313.75
Max. Negotiated Rate	$7,712.50
Rate for Payer: Aetna Commercial	$4,627.50
Rate for Payer: Aetna Medicare Advantage	$4,627.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,933.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,933.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,933.38
Rate for Payer: Cigna Commercial	$7,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,732.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,313.75

STENT ILIAC LEG G55245

Facility

$15,425.00

Hospital Charge Code	270647930C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,313.75
Max. Negotiated Rate	$3,732.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,732.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,313.75

STENT ILIAC LEG G55247

Facility

$15,425.00

Hospital Charge Code	270647929C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,313.75
Max. Negotiated Rate	$7,712.50
Rate for Payer: Aetna Commercial	$4,627.50
Rate for Payer: Aetna Medicare Advantage	$4,627.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,933.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,933.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,933.38
Rate for Payer: Cigna Commercial	$7,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,732.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,313.75

STENT ILIAC LEG G55247

Facility

$15,425.00

Hospital Charge Code	270647929C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,313.75
Max. Negotiated Rate	$3,732.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,732.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,313.75

STENT ILIAC SMRT 8/40 C08040SB

Facility

$8,225.00

Hospital Charge Code	270628376V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.75
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$2,467.50
Rate for Payer: Aetna Medicare Advantage	$2,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.38
Rate for Payer: Cigna Commercial	$4,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75

STENT ILIAC SMRT 8/40 C08040SB

Facility

$8,159.25

Hospital Charge Code	270628376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.89
Max. Negotiated Rate	$4,079.62
Rate for Payer: Aetna Commercial	$2,447.78
Rate for Payer: Aetna Medicare Advantage	$2,447.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,080.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,080.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,631.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,080.61
Rate for Payer: Cigna Commercial	$4,079.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,974.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,223.89

STENT ILIAC SMRT 8/40 C08040SB

Facility

$8,225.00

Hospital Charge Code	270628376V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.75
Max. Negotiated Rate	$1,990.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75

STENT ILIAC SMRT 8/40 C08040SB

Facility

$8,159.25

Hospital Charge Code	270628376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.89
Max. Negotiated Rate	$1,974.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,631.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,974.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,223.89

Stent INLAY 6 FR 22-32 cm

Facility

$295.00

Service Code	HCPCS C1725
Hospital Charge Code	270626655
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 INLAY 6 FR 22-32 cm

Facility

$295.00

Service Code	HCPCS C1725
Hospital Charge Code	270626655
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 INLAY 7FR 22-32CM

Facility

$295.00

Hospital Charge Code	270682457
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 INLAY 7FR 22-32CM

Facility

$295.00

Hospital Charge Code	270682457
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 INLAY 7 FR 22 CM

Facility

$295.00

Hospital Charge Code	270682458
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 INLAY 7 FR 22 CM

Facility

$295.00

Hospital Charge Code	270682458
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 INLAY 7 FR 24 CM

Facility

$295.00

Hospital Charge Code	270682459
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 INLAY 7 FR 24 CM

Facility

$295.00

Hospital Charge Code	270682459
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 INLAY 7 FR 26 CM

Facility

$295.00

Hospital Charge Code	270682460
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 INLAY 7 FR 26 CM

Facility

$295.00

Hospital Charge Code	270682460
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 INLAY 8 FR 22-32 CM

Facility

$295.00

Hospital Charge Code	270682471
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 INLAY 8 FR 22-32 CM

Facility

$295.00

Hospital Charge Code	270682471
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 INLAY 8FR 22 CM

Facility

$295.00

Hospital Charge Code	270682461
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

Know your out-of-pocket cost for care.

All Charges