Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 PERC PLUS 4.8X 22 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696154
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$348.86
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT PERC PLUS 4.8X 22 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696154
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT PERCUFLEX

Facility

$630.00

Service Code	HCPCS C2617
Hospital Charge Code	270650848
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

STENT PERCUFLEX

Facility

$630.00

Service Code	HCPCS C2617
Hospital Charge Code	270650848
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

STENT PERCUFLEX 10X10

Facility

$495.00

Hospital Charge Code	270654283
Hospital Revenue Code	270
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

STENT PERCUFLEX 10X10

Facility

$495.00

Hospital Charge Code	270654283
Hospital Revenue Code	270
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.35
Rate for Payer: Oxford Commercial	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$247.50

STENT PERCUFLEX 10x12

Facility

$475.00

Hospital Charge Code	270650918
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERCUFLEX 10x12

Facility

$475.00

Hospital Charge Code	270650918
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERCUFLEX 10x12

Facility

$495.00

Hospital Charge Code	270654288
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

STENT PERCUFLEX 10x12

Facility

$495.00

Hospital Charge Code	270654288
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

STENT PERCUFLEX 7FR 24 175-272

Facility

$694.45

Hospital Charge Code	270623138
Hospital Revenue Code	278
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$347.23
Rate for Payer: Aetna Commercial	$208.34
Rate for Payer: Aetna Medicare Advantage	$208.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.08
Rate for Payer: Cigna Commercial	$347.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.06
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STENT PERCUFLEX 7FR 24 175-272

Facility

$694.45

Hospital Charge Code	270623138
Hospital Revenue Code	278
Min. Negotiated Rate	$104.17
Max. Negotiated Rate	$168.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.06
Rate for Payer: Qualcare PPO/HMO/WC	$104.17

STENT PERCUFLEX 7x10

Facility

$535.00

Hospital Charge Code	270650915
Hospital Revenue Code	278
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$267.50
Rate for Payer: Aetna Commercial	$160.50
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.43
Rate for Payer: Cigna Commercial	$267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.47
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

STENT PERCUFLEX 7x10

Facility

$535.00

Hospital Charge Code	270650915
Hospital Revenue Code	278
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$129.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.47
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

STENT PERCUFLEX 7x5

Facility

$495.00

Hospital Charge Code	270650913
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

STENT PERCUFLEX 7x5

Facility

$495.00

Hospital Charge Code	270650913
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

STENT PERCUFLEX 8FR 22cm

Facility

$618.00

Service Code	HCPCS C2617
Hospital Charge Code	270623953
Hospital Revenue Code	278
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$309.00
Rate for Payer: Aetna Commercial	$185.40
Rate for Payer: Aetna Medicare Advantage	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.59
Rate for Payer: Cigna Commercial	$309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

STENT PERCUFLEX 8FR 22cm

Facility

$618.00

Service Code	HCPCS C2617
Hospital Charge Code	270623953
Hospital Revenue Code	278
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$149.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

STENT PERCUFLEX PLUS URTERAL

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658587
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$98.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT PERCUFLEX PLUS URTERAL

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658587
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$203.12
Rate for Payer: Aetna Commercial	$121.88
Rate for Payer: Aetna Medicare Advantage	$121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.59
Rate for Payer: Cigna Commercial	$203.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT PERCULFLEX 7x12

Facility

$475.00

Hospital Charge Code	270650917
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERCULFLEX 7x12

Facility

$475.00

Hospital Charge Code	270650917
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERFCUFLEX 7x7

Facility

$475.00

Hospital Charge Code	270650914
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

STENT PERFCUFLEX 7x7

Facility

$475.00

Hospital Charge Code	270650914
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

Know your out-of-pocket cost for care.

All Charges