Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$2,752.80
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$4,588.00
Rate for Payer: Aetna Commercial	$2,752.80
Rate for Payer: Aetna Medicare Advantage	$2,752.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.88
Rate for Payer: Cigna Commercial	$4,588.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT P GPS SERB65-07-120-120

Facility

$9,176.00

Hospital Charge Code	270635522V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,220.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.40

STENT PIGTAIL 10FR 7cm

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270658551
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT PIGTAIL 10FR 7cm

Facility

$275.00

Service Code	HCPCS C2617
Hospital Charge Code	270658551
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

STENT PIGTAIL 5 24CM *****

Facility

$414.00

Hospital Charge Code	1603927
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 24CM *****

Facility

$414.00

Hospital Charge Code	1603927
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 24CM 031524***

Facility

$414.00

Hospital Charge Code	1604370
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 24CM 031524***

Facility

$414.00

Hospital Charge Code	1604370
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 25CM ******

Facility

$414.00

Hospital Charge Code	1605138
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 25CM ******

Facility

$414.00

Hospital Charge Code	1605138
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 5 27CM 031527***

Facility

$414.00

Hospital Charge Code	1604339
Hospital Revenue Code	272
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.82
Rate for Payer: Oxford Commercial	$207.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$207.00

STENT PIGTAIL 5 27CM 031527***

Facility

$414.00

Hospital Charge Code	1604339
Hospital Revenue Code	272
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 7 27CM 031727***

Facility

$414.00

Hospital Charge Code	1604347
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 7 27CM 031727***

Facility

$414.00

Hospital Charge Code	1604347
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL 7FR/10CM

Facility

$295.00

Hospital Charge Code	270655036
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT PIGTAIL 7FR/10CM

Facility

$295.00

Hospital Charge Code	270655036
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT PIGTAIL DBL 7F 25CM****

Facility

$414.00

Hospital Charge Code	1604354
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTAIL DBL 7F 25CM****

Facility

$414.00

Hospital Charge Code	1604354
Hospital Revenue Code	278
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.19
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

STENT PIGTL DRAIN 10 5CM 3204

Facility

$502.45

Hospital Charge Code	270600941
Hospital Revenue Code	278
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$121.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

STENT PIGTL DRAIN 10 5CM 3204

Facility

$502.45

Hospital Charge Code	270600941
Hospital Revenue Code	278
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$251.22
Rate for Payer: Aetna Commercial	$150.74
Rate for Payer: Aetna Medicare Advantage	$150.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.12
Rate for Payer: Cigna Commercial	$251.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

STENT PIGTL DRAIN 7FR 5CM 3201

Facility

$502.45

Hospital Charge Code	270600937
Hospital Revenue Code	278
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$121.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

STENT PIGTL DRAIN 7FR 5CM 3201

Facility

$502.45

Hospital Charge Code	270600937
Hospital Revenue Code	278
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$251.22
Rate for Payer: Aetna Commercial	$150.74
Rate for Payer: Aetna Medicare Advantage	$150.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.12
Rate for Payer: Cigna Commercial	$251.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.59
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

STENT PIPELINESHIELD 4.25X12MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270699009S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

Know your out-of-pocket cost for care.

All Charges