Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT PROMUS 3.0 X 38MM

Facility

$8,175.00

Hospital Charge Code	270660743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.25
Max. Negotiated Rate	$1,978.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.25

STENT PROMUS 3.0 X 38MM

Facility

$8,175.00

Hospital Charge Code	270660743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.25
Max. Negotiated Rate	$4,087.50
Rate for Payer: Aetna Commercial	$2,452.50
Rate for Payer: Aetna Medicare Advantage	$2,452.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,084.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,084.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,084.62
Rate for Payer: Cigna Commercial	$4,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.25

STENT PROMUS 3 5X12 391141235

Facility

$8,750.00

Hospital Charge Code	270660748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT PROMUS 3 5X12 391141235

Facility

$8,750.00

Hospital Charge Code	270660748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT PROMUS 3.5 X 20MM

Facility

$7,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270665444
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 PROMUS 3.5 X 20MM

Facility

$7,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270665444
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 PROMUS 3 5X24 391142435

Facility

$8,500.00

Hospital Charge Code	270660747
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

STENT PROMUS 3 5X24 391142435

Facility

$8,500.00

Hospital Charge Code	270660747
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

STENT PROMUS 3 5 X 24MM

Facility

$5,257.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471N
Hospital Revenue Code	278
Min. Negotiated Rate	$788.55
Max. Negotiated Rate	$1,272.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,051.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.19
Rate for Payer: Qualcare PPO/HMO/WC	$788.55

STENT PROMUS 3 5 X 24MM

Facility

$5,257.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471N
Hospital Revenue Code	278
Min. Negotiated Rate	$788.55
Max. Negotiated Rate	$2,628.50
Rate for Payer: Aetna Commercial	$1,577.10
Rate for Payer: Aetna Medicare Advantage	$1,577.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,340.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,340.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,051.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,340.54
Rate for Payer: Cigna Commercial	$2,628.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.19
Rate for Payer: Qualcare PPO/HMO/WC	$788.55

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471
Hospital Revenue Code	278
Min. Negotiated Rate	$952.50
Max. Negotiated Rate	$3,175.00
Rate for Payer: Aetna Commercial	$1,905.00
Rate for Payer: Aetna Medicare Advantage	$1,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,619.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,619.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,619.25
Rate for Payer: Cigna Commercial	$3,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471S
Hospital Revenue Code	278
Min. Negotiated Rate	$952.50
Max. Negotiated Rate	$1,536.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471
Hospital Revenue Code	278
Min. Negotiated Rate	$952.50
Max. Negotiated Rate	$1,536.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471S
Hospital Revenue Code	278
Min. Negotiated Rate	$952.50
Max. Negotiated Rate	$3,175.00
Rate for Payer: Aetna Commercial	$1,905.00
Rate for Payer: Aetna Medicare Advantage	$1,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,619.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,619.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,619.25
Rate for Payer: Cigna Commercial	$3,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50

STENT PROMUS 4.0X18 100954318B

Facility

$10,250.00

Hospital Charge Code	270642613C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PROMUS 4.0X18 100954318B

Facility

$10,250.00

Hospital Charge Code	270642613C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PROMUS 4.0X20 391142040

Facility

$8,750.00

Hospital Charge Code	270660745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT PROMUS 4.0X20 391142040

Facility

$8,750.00

Hospital Charge Code	270660745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT PROMUS ELEMENT PLUS 3.0X

Facility

$7,475.00

Hospital Charge Code	270665580
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 PROMUS ELEMENT PLUS 3.0X

Facility

$7,475.00

Hospital Charge Code	270665580
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 PROMUS RX 2.5x28mm

Facility

$10,250.00

Hospital Charge Code	270641890C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PROMUS RX 2.5x28mm

Facility

$10,250.00

Hospital Charge Code	270641890C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PROMUS RX 2.75X8MM

Facility

$10,250.00

Hospital Charge Code	270642004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PROMUS RX 2.75X8MM

Facility

$10,250.00

Hospital Charge Code	270642004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT PROMUS RX 3.0X28MM

Facility

$10,250.00

Hospital Charge Code	270641996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

Know your out-of-pocket cost for care.

All Charges