Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT METALLIC URETERAL 22CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674321
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 24CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674322
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$2,385.00
Rate for Payer: Aetna Commercial	$1,431.00
Rate for Payer: Aetna Medicare Advantage	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,216.35
Rate for Payer: Cigna Commercial	$2,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 24CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674322
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 26CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674323
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 26CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674323
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$2,385.00
Rate for Payer: Aetna Commercial	$1,431.00
Rate for Payer: Aetna Medicare Advantage	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,216.35
Rate for Payer: Cigna Commercial	$2,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 28CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674324
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$2,385.00
Rate for Payer: Aetna Commercial	$1,431.00
Rate for Payer: Aetna Medicare Advantage	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,216.35
Rate for Payer: Cigna Commercial	$2,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 28CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674324
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 30CM

Facility

$4,770.00

Hospital Charge Code	270674325
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 30CM

Facility

$4,770.00

Hospital Charge Code	270674325
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$2,385.00
Rate for Payer: Aetna Commercial	$1,431.00
Rate for Payer: Aetna Medicare Advantage	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,216.35
Rate for Payer: Cigna Commercial	$2,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT MINI MONOKA

Facility

$291.67

Hospital Charge Code	270673867
Hospital Revenue Code	278
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$145.84
Rate for Payer: Aetna Commercial	$87.50
Rate for Payer: Aetna Medicare Advantage	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.38
Rate for Payer: Cigna Commercial	$145.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.58
Rate for Payer: Qualcare PPO/HMO/WC	$43.75

STENT MINI MONOKA

Facility

$291.67

Hospital Charge Code	270673867
Hospital Revenue Code	278
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$70.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.58
Rate for Payer: Qualcare PPO/HMO/WC	$43.75

STENT MINI VISION RX 2.25 X 18

Facility

$3,450.00

Hospital Charge Code	270643604
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,035.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MINI VISION RX 2.25 X 18

Facility

$3,450.00

Hospital Charge Code	270643604
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$834.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MINI VISION RX 2.25X18

Facility

$3,450.00

Hospital Charge Code	2709001099
Hospital Revenue Code	272
Min. Negotiated Rate	$448.50
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,035.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.50
Rate for Payer: Oxford Commercial	$1,725.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$1,725.00

STENT MINI VISION RX 2.25X18

Facility

$3,450.00

Hospital Charge Code	2709001099
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MINI VISION RX 2.5 X 08

Facility

$4,920.00

Hospital Charge Code	2709002911
Hospital Revenue Code	272
Min. Negotiated Rate	$639.60
Max. Negotiated Rate	$2,460.00
Rate for Payer: Aetna Commercial	$1,476.00
Rate for Payer: Aetna Medicare Advantage	$1,476.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,254.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,254.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,254.60
Rate for Payer: Cigna Commercial	$2,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$639.60
Rate for Payer: Oxford Commercial	$2,460.00
Rate for Payer: Qualcare PPO/HMO/WC	$738.00
Rate for Payer: UnitedHealthcare Commercial	$2,460.00

STENT MINI VISION RX 2.5 X 08

Facility

$4,920.00

Hospital Charge Code	2709002911
Hospital Revenue Code	272
Min. Negotiated Rate	$738.00
Max. Negotiated Rate	$738.00
Rate for Payer: Qualcare PPO/HMO/WC	$738.00

STENT MINI VISION RX 2.5 X 08

Facility

$4,920.00

Hospital Charge Code	270643606
Hospital Revenue Code	278
Min. Negotiated Rate	$738.00
Max. Negotiated Rate	$2,460.00
Rate for Payer: Aetna Commercial	$1,476.00
Rate for Payer: Aetna Medicare Advantage	$1,476.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,254.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,254.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$984.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,254.60
Rate for Payer: Cigna Commercial	$2,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,190.64
Rate for Payer: Qualcare PPO/HMO/WC	$738.00

STENT MINI VISION RX 2.5 X 08

Facility

$4,920.00

Hospital Charge Code	270643606
Hospital Revenue Code	278
Min. Negotiated Rate	$738.00
Max. Negotiated Rate	$1,190.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$984.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,190.64
Rate for Payer: Qualcare PPO/HMO/WC	$738.00

STENT MINI VISION RX 2.5 X 12

Facility

$3,450.00

Hospital Charge Code	270643607
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$834.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MINI VISION RX 2.5 X 12

Facility

$3,450.00

Hospital Charge Code	270643607
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,035.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MINI VISION RX 2.5X12

Facility

$3,450.00

Hospital Charge Code	2709001100
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MINI VISION RX 2.5X12

Facility

$3,450.00

Hospital Charge Code	2709001100
Hospital Revenue Code	272
Min. Negotiated Rate	$448.50
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,035.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.50
Rate for Payer: Oxford Commercial	$1,725.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$1,725.00

STENT MINI VISION RX 2.5 X 15

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643608
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MINI VISION RX 2.5 X 15

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643608
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Know your out-of-pocket cost for care.

All Charges