Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT MINI VISION RX 2.5X15

Facility

$3,450.00

Hospital Charge Code	2709001101
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 2.5X15

Facility

$3,450.00

Hospital Charge Code	2709001101
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 18

Facility

$3,450.00

Hospital Charge Code	2709001102
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 18

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643367
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 18

Facility

$3,450.00

Hospital Charge Code	2709001102
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 18

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643367
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

STENT MINI VISION RX 2.5 X 23

Facility

$3,450.00

Hospital Charge Code	2709001103
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 23

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643419
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

STENT MINI VISION RX 2.5 X 23

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643419
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 23

Facility

$3,450.00

Hospital Charge Code	2709001103
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT MONORAIL P07040RXB

Facility

$10,639.25

Hospital Charge Code	270633606
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.89
Max. Negotiated Rate	$2,574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89

STENT MONORAIL P07040RXB

Facility

$10,639.25

Hospital Charge Code	270633606
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.89
Max. Negotiated Rate	$5,319.62
Rate for Payer: Aetna Commercial	$3,191.78
Rate for Payer: Aetna Medicare Advantage	$3,191.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.01
Rate for Payer: Cigna Commercial	$5,319.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89

STENT MT ENDOPROS 12 90 40-213

Facility

$8,248.00

Hospital Charge Code	270626416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.20
Max. Negotiated Rate	$4,124.00
Rate for Payer: Aetna Commercial	$2,474.40
Rate for Payer: Aetna Medicare Advantage	$2,474.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,649.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.24
Rate for Payer: Cigna Commercial	$4,124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.20

STENT MT ENDOPROS 12 90 40-213

Facility

$8,248.00

Hospital Charge Code	270626416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.20
Max. Negotiated Rate	$1,996.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,649.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.20

STENT MT ENDOPROS 12 90 40-213

Facility

$8,248.00

Hospital Charge Code	270626416V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.20
Max. Negotiated Rate	$1,996.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,649.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.20

STENT MT ENDOPROS 12 90 40-213

Facility

$8,248.00

Hospital Charge Code	270626416V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.20
Max. Negotiated Rate	$4,124.00
Rate for Payer: Aetna Commercial	$2,474.40
Rate for Payer: Aetna Medicare Advantage	$2,474.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,649.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.24
Rate for Payer: Cigna Commercial	$4,124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.20

STENT MT ILIAC 10 20 42051

Facility

$4,552.85

Hospital Charge Code	270616369
Hospital Revenue Code	278
Min. Negotiated Rate	$682.93
Max. Negotiated Rate	$2,276.43
Rate for Payer: Aetna Commercial	$1,365.86
Rate for Payer: Aetna Medicare Advantage	$1,365.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,160.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,160.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,160.98
Rate for Payer: Cigna Commercial	$2,276.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.79
Rate for Payer: Qualcare PPO/HMO/WC	$682.93

STENT MT ILIAC 10 20 42051

Facility

$4,552.85

Hospital Charge Code	270616369
Hospital Revenue Code	278
Min. Negotiated Rate	$682.93
Max. Negotiated Rate	$1,101.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.79
Rate for Payer: Qualcare PPO/HMO/WC	$682.93

STENT MT ILIAC 6 135 71-127

Facility

$6,052.00

Hospital Charge Code	270623795V
Hospital Revenue Code	278
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$1,464.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.58
Rate for Payer: Qualcare PPO/HMO/WC	$907.80

STENT MT ILIAC 6 135 71-127

Facility

$6,052.00

Hospital Charge Code	270623795
Hospital Revenue Code	278
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$1,464.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.58
Rate for Payer: Qualcare PPO/HMO/WC	$907.80

STENT MT ILIAC 6 135 71-127

Facility

$6,052.00

Hospital Charge Code	270623795V
Hospital Revenue Code	278
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$3,026.00
Rate for Payer: Aetna Commercial	$1,815.60
Rate for Payer: Aetna Medicare Advantage	$1,815.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,543.26
Rate for Payer: Cigna Commercial	$3,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.58
Rate for Payer: Qualcare PPO/HMO/WC	$907.80

STENT MT ILIAC 6 135 71-127

Facility

$6,052.00

Hospital Charge Code	270623795
Hospital Revenue Code	278
Min. Negotiated Rate	$907.80
Max. Negotiated Rate	$3,026.00
Rate for Payer: Aetna Commercial	$1,815.60
Rate for Payer: Aetna Medicare Advantage	$1,815.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,543.26
Rate for Payer: Cigna Commercial	$3,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.58
Rate for Payer: Qualcare PPO/HMO/WC	$907.80

STENT MT ILIAC 6 75 17-126

Facility

$6,832.00

Hospital Charge Code	270626876V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.80
Max. Negotiated Rate	$1,653.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,366.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,653.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,024.80

STENT MT ILIAC 6 75 17-126

Facility

$6,832.00

Hospital Charge Code	270626876V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.80
Max. Negotiated Rate	$3,416.00
Rate for Payer: Aetna Commercial	$2,049.60
Rate for Payer: Aetna Medicare Advantage	$2,049.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,742.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,742.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,366.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,742.16
Rate for Payer: Cigna Commercial	$3,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,653.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,024.80

STENT MT ILIAC WSRP 7 71-136

Facility

$5,165.60

Hospital Charge Code	270623270V
Hospital Revenue Code	278
Min. Negotiated Rate	$774.84
Max. Negotiated Rate	$1,250.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,250.08
Rate for Payer: Qualcare PPO/HMO/WC	$774.84

Know your out-of-pocket cost for care.

All Charges