Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT PERIP 4 5X80 S45080120P6

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668911
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$4,402.50
Rate for Payer: Aetna Commercial	$2,641.50
Rate for Payer: Aetna Medicare Advantage	$2,641.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,761.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERIP 4 5X80 S45080120P6

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668911
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$2,130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,761.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	366836903
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$14,622.47
Rate for Payer: Aetna Medicare Advantage	$14,622.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,429.10
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,336.40
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	2709024
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	321036903
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	7412058
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	2709024
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$14,622.47
Rate for Payer: Aetna Medicare Advantage	$14,622.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,429.10
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,336.40
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	2692129
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$16,986.28
Rate for Payer: Aetna Medicare Advantage	$16,986.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,438.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,438.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,438.34
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,360.72
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	5100837
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$14,622.47
Rate for Payer: Aetna Medicare Advantage	$14,622.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,429.10
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,336.40
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	2692129
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	321036903
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$16,986.28
Rate for Payer: Aetna Medicare Advantage	$16,986.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,438.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,438.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,438.34
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,360.72
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	7412058
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$14,622.47
Rate for Payer: Aetna Medicare Advantage	$14,622.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,429.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,429.10
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,336.40
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	366836903
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	5100837
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064
Hospital Revenue Code	272
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$1,491.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064
Hospital Revenue Code	272
Min. Negotiated Rate	$1,292.85
Max. Negotiated Rate	$4,972.50
Rate for Payer: Aetna Commercial	$2,983.50
Rate for Payer: Aetna Medicare Advantage	$2,983.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,535.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,535.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,535.97
Rate for Payer: Cigna Commercial	$4,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,292.85
Rate for Payer: Oxford Commercial	$4,972.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75
Rate for Payer: UnitedHealthcare Commercial	$4,972.50

STENT PERIPHERAL 5.5X40MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270669063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5X40MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270669063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890
Hospital Revenue Code	272
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$1,320.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890
Hospital Revenue Code	272
Min. Negotiated Rate	$1,144.65
Max. Negotiated Rate	$4,402.50
Rate for Payer: Aetna Commercial	$2,641.50
Rate for Payer: Aetna Medicare Advantage	$2,641.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.65
Rate for Payer: Oxford Commercial	$4,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Commercial	$4,402.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5.5x80MM 6FR

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668890N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT PERIPHERAL 5x100x120 6F

Facility

$8,805.00

Hospital Charge Code	270705281
Hospital Revenue Code	272
Min. Negotiated Rate	$1,144.65
Max. Negotiated Rate	$4,402.50
Rate for Payer: Aetna Commercial	$2,641.50
Rate for Payer: Aetna Medicare Advantage	$2,641.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.65
Rate for Payer: Oxford Commercial	$4,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Commercial	$4,402.50

Know your out-of-pocket cost for care.

All Charges