Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT LIBERTE 275x20 389342027

Facility

$4,375.00

Hospital Charge Code	270637490
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 275x20 389342027

Facility

$4,375.00

Hospital Charge Code	270637490
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 2 75x8 38934827

Facility

$4,375.00

Hospital Charge Code	270638260C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 2 75x8 38934827

Facility

$4,375.00

Hospital Charge Code	270638260C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 0x12 389341230

Facility

$4,375.00

Hospital Charge Code	270638462C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 0x12 389341230

Facility

$4,375.00

Hospital Charge Code	270638462C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 50x8 38934835

Facility

$4,375.00

Hospital Charge Code	270638460
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 50x8 38934835

Facility

$4,375.00

Hospital Charge Code	270638460
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 5x12 389341235

Facility

$4,375.00

Hospital Charge Code	270638315C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 5x12 389341235

Facility

$4,375.00

Hospital Charge Code	270638315C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580C
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,302.00
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 3 5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580C
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 3.5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 3.5X12 389351235

Facility

$4,340.00

Hospital Charge Code	270636580
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,302.00
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 3 5x20 389342035

Facility

$4,375.00

Hospital Charge Code	270637881C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 3 5x20 389342035

Facility

$4,375.00

Hospital Charge Code	270637881C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 4.0x12 389341240

Facility

$4,375.00

Hospital Charge Code	270638226C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 4.0x12 389341240

Facility

$4,375.00

Hospital Charge Code	270638226C
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STENT LIBERTE 4.0X16 389351640

Facility

$4,340.00

Hospital Charge Code	270636694
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,302.00
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 4.0X16 389351640

Facility

$4,340.00

Hospital Charge Code	270636694
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 5.0X12MM 3891250

Facility

$4,340.00

Hospital Charge Code	270636555
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$1,302.00
Rate for Payer: Aetna Medicare Advantage	$1,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,106.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,106.70
Rate for Payer: Cigna Commercial	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 5.0X12MM 3891250

Facility

$4,340.00

Hospital Charge Code	270636555
Hospital Revenue Code	278
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$1,050.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.28
Rate for Payer: Qualcare PPO/HMO/WC	$651.00

STENT LIBERTE 5 0x20 389342050

Facility

$8,750.00

Hospital Charge Code	270637673C
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 LIBERTE 5 0x20 389342050

Facility

$8,750.00

Hospital Charge Code	270637673C
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 LIBERTE 5.x20 38934-2050

Facility

$8,750.00

Hospital Charge Code	270637673
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

Know your out-of-pocket cost for care.

All Charges