Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT LIB MON 3.0X16 389341630

Facility

$1,250.00

Hospital Charge Code	270638613
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

STENT LIB MON 3.0X16 389341630

Facility

$1,250.00

Hospital Charge Code	270638613
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

STENT LIB MON 3.5x24 389342435

Facility

$4,375.00

Hospital Charge Code	270639211
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 LIB MON 3.5x24 389342435

Facility

$4,375.00

Hospital Charge Code	270639211
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 LIB MON 3.5X32 389343235

Facility

$1,250.00

Hospital Charge Code	270639380
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

STENT LIB MON 3.5X32 389343235

Facility

$1,250.00

Hospital Charge Code	270639380
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

STENT LIB MON 4.5x16 389341645

Facility

$4,375.00

Hospital Charge Code	270639383
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 LIB MON 4.5x16 389341645

Facility

$4,375.00

Hospital Charge Code	270639383
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 LIB MONO 3x16 389341630

Facility

$4,375.00

Hospital Charge Code	270638613C
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 LIB MONO 3x16 389341630

Facility

$4,375.00

Hospital Charge Code	270638613C
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 LIB OTW 2.7X16 389351627

Facility

$4,375.00

Hospital Charge Code	270637192C
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 LIB OTW 2.7X16 389351627

Facility

$4,375.00

Hospital Charge Code	270637192C
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 LIB OTW 3 5X16 389351635

Facility

$4,375.00

Hospital Charge Code	270637375C
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 LIB OTW 3 5X16 389351635

Facility

$4,375.00

Hospital Charge Code	270637375C
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 LIFE 6MMx60MMx130CM

Facility

$9,375.00

Hospital Charge Code	270671188
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

STENT LIFE 6MMx60MMx130CM

Facility

$9,375.00

Hospital Charge Code	270671188
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$2,812.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

STENT LIFESTAR 10 X 40 X 80

Facility

$4,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270688130
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STENT LIFESTAR 10 X 40 X 80

Facility

$4,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270688130
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STENT LUMINEXX 10x40 LXM10040

Facility

$7,440.00

Hospital Charge Code	270629417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,116.00
Max. Negotiated Rate	$1,800.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.00

STENT LUMINEXX 10x40 LXM10040

Facility

$7,440.00

Hospital Charge Code	270629417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,116.00
Max. Negotiated Rate	$3,720.00
Rate for Payer: Aetna Commercial	$2,232.00
Rate for Payer: Aetna Medicare Advantage	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,897.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,897.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,897.20
Rate for Payer: Cigna Commercial	$3,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.00

STENT LUMINEXX 10x60 LXM10060

Facility

$7,911.25

Hospital Charge Code	270631049V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.69
Max. Negotiated Rate	$3,955.62
Rate for Payer: Aetna Commercial	$2,373.38
Rate for Payer: Aetna Medicare Advantage	$2,373.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,017.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,017.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,017.37
Rate for Payer: Cigna Commercial	$3,955.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,914.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,186.69

STENT LUMINEXX 10x60 LXM10060

Facility

$7,911.25

Hospital Charge Code	270631049
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.69
Max. Negotiated Rate	$3,955.62
Rate for Payer: Aetna Commercial	$2,373.38
Rate for Payer: Aetna Medicare Advantage	$2,373.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,017.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,017.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,017.37
Rate for Payer: Cigna Commercial	$3,955.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,914.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,186.69

STENT LUMINEXX 10x60 LXM10060

Facility

$7,911.25

Hospital Charge Code	270631049V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.69
Max. Negotiated Rate	$1,914.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,914.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,186.69

STENT LUMINEXX 10x60 LXM10060

Facility

$7,911.25

Hospital Charge Code	270631049
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.69
Max. Negotiated Rate	$1,914.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,914.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,186.69

STENT LUMINEXX 12x40 LXM12040

Facility

$8,159.25

Hospital Charge Code	270635338
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

Know your out-of-pocket cost for care.

All Charges