Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT MULT UL 5.0X13 100338213

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT MULT UL 5.0X13 100338213

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935C
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 MULT UL 5.0X13 100338213

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643935C
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 MUL ULT 4.5X28 100338128

Facility

$4,875.00

Hospital Charge Code	270643418C
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT MUL ULT 4.5X28 100338128

Facility

$4,875.00

Hospital Charge Code	270643418C
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951N
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$154.88
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951S
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951S
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$154.88
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951N
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$154.88
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROURETERAL 24CM 8FR

Facility

$820.00

Service Code	HCPCS C2617
Hospital Charge Code	270691572
Hospital Revenue Code	278
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$198.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

STENT NEPHROURETERAL 24CM 8FR

Facility

$820.00

Service Code	HCPCS C2617
Hospital Charge Code	270691572
Hospital Revenue Code	278
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$246.00
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

STENT NEUROFORM ATLAS 3X21MM

Facility

$39,226.75

Service Code	HCPCS C1876
Hospital Charge Code	270697798S
Hospital Revenue Code	278
Min. Negotiated Rate	$5,884.01
Max. Negotiated Rate	$9,492.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,845.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,492.87
Rate for Payer: Qualcare PPO/HMO/WC	$5,884.01

STENT NEUROFORM ATLAS 3X21MM

Facility

$39,226.75

Service Code	HCPCS C1876
Hospital Charge Code	270697798S
Hospital Revenue Code	278
Min. Negotiated Rate	$5,884.01
Max. Negotiated Rate	$19,613.38
Rate for Payer: Aetna Commercial	$11,768.02
Rate for Payer: Aetna Medicare Advantage	$11,768.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,002.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,002.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,845.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,002.82
Rate for Payer: Cigna Commercial	$19,613.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,492.87
Rate for Payer: Qualcare PPO/HMO/WC	$5,884.01

STENT NEUROFORM ATLAS 4X24MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697804S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$9,919.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLAS 4X24MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697804S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$20,494.88
Rate for Payer: Aetna Commercial	$12,296.92
Rate for Payer: Aetna Medicare Advantage	$12,296.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.39
Rate for Payer: Cigna Commercial	$20,494.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLASZ4.5X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697805S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$9,919.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLASZ4.5X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697805S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$20,494.88
Rate for Payer: Aetna Commercial	$12,296.92
Rate for Payer: Aetna Medicare Advantage	$12,296.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.39
Rate for Payer: Cigna Commercial	$20,494.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLAS Z 4X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697802S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$20,494.88
Rate for Payer: Aetna Commercial	$12,296.92
Rate for Payer: Aetna Medicare Advantage	$12,296.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.39
Rate for Payer: Cigna Commercial	$20,494.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLAS Z 4X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697802S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$9,919.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT OMNILINK 10.0x29MMx135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648338
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,162.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 10.0x29MMx135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648338
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 10.0X29MMX135CM

Facility

$4,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270648338C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT OMNILINK 10.0X29MMX135CM

Facility

$4,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270648338C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

Know your out-of-pocket cost for care.

All Charges