Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT PACIFIC PLUS 6X40X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683562N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X40X180

Facility

$1,047.40

Service Code	HCPCS C1876
Hospital Charge Code	270683562
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PALMAZ XL 30MM P3110

Facility

$7,675.00

Hospital Charge Code	270641380
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$1,857.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

STENT PALMAZ XL 30MM P3110

Facility

$7,675.00

Hospital Charge Code	270641380
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$3,837.50
Rate for Payer: Aetna Commercial	$2,302.50
Rate for Payer: Aetna Medicare Advantage	$2,302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.12
Rate for Payer: Cigna Commercial	$3,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

STENT PALMAZ XL 40MM

Facility

$6,925.00

Hospital Charge Code	270634569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.75
Max. Negotiated Rate	$1,675.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.75

STENT PALMAZ XL 40MM

Facility

$6,925.00

Hospital Charge Code	270634569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.75
Max. Negotiated Rate	$3,462.50
Rate for Payer: Aetna Commercial	$2,077.50
Rate for Payer: Aetna Medicare Advantage	$2,077.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,765.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,765.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,765.88
Rate for Payer: Cigna Commercial	$3,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.75

STENT PALMAZ XL 50MM

Facility

$7,475.00

Hospital Charge Code	270634568
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

STENT PALMAZ XL 50MM

Facility

$7,475.00

Hospital Charge Code	270634568
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

STENT PANCREATIC 4 FR X 4 CM

Facility

$385.95

Service Code	HCPCS C2617
Hospital Charge Code	270679146
Hospital Revenue Code	278
Min. Negotiated Rate	$57.89
Max. Negotiated Rate	$192.97
Rate for Payer: Aetna Commercial	$115.78
Rate for Payer: Aetna Medicare Advantage	$115.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.42
Rate for Payer: Cigna Commercial	$192.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.40
Rate for Payer: Qualcare PPO/HMO/WC	$57.89

STENT PANCREATIC 4 FR X 4 CM

Facility

$385.95

Service Code	HCPCS C2617
Hospital Charge Code	270679146
Hospital Revenue Code	278
Min. Negotiated Rate	$57.89
Max. Negotiated Rate	$93.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.40
Rate for Payer: Qualcare PPO/HMO/WC	$57.89

STENT PANCREATIC 4FRX7CM

Facility

$1,150.00

Hospital Charge Code	270670583
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$345.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

STENT PANCREATIC 4FRX7CM

Facility

$1,150.00

Hospital Charge Code	270670583
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

STENT PAPYRUS 2.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691980
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 2.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691980
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 2.5X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691981
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 2.5X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691981
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691984
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691984
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691982
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691982
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691983
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

Know your out-of-pocket cost for care.

All Charges