Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT PROTEGE 14x60mm 80cm

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270637001
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE 14x60mm 80cm

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637001N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE 14x60mm 80cm

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637001N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE 14x60mm 80cm

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270637001
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$1,987.44
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE 14x60mm 80cm

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270637001C
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$1,987.44
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE 14x60mm 80cm

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270637001C
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE 6FR 8 60M

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE 6FR 8 60M

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE 6FR GPS .035

Facility

$6,125.00

Service Code	HCPCS C1876
Hospital Charge Code	270658406
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$1,482.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

STENT PROTEGE 6FR GPS .035

Facility

$6,125.00

Service Code	HCPCS C1876
Hospital Charge Code	270658406N
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$3,062.50
Rate for Payer: Aetna Commercial	$1,837.50
Rate for Payer: Aetna Medicare Advantage	$1,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.88
Rate for Payer: Cigna Commercial	$3,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

STENT PROTEGE 6FR GPS .035

Facility

$6,125.00

Service Code	HCPCS C1876
Hospital Charge Code	270658406
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$3,062.50
Rate for Payer: Aetna Commercial	$1,837.50
Rate for Payer: Aetna Medicare Advantage	$1,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.88
Rate for Payer: Cigna Commercial	$3,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

STENT PROTEGE 6FR GPS .035

Facility

$6,125.00

Service Code	HCPCS C1876
Hospital Charge Code	270658406N
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$1,482.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

STENT PROTEGE 6FR GPS.035

Facility

$6,975.00

Hospital Charge Code	2709002175
Hospital Revenue Code	272
Min. Negotiated Rate	$906.75
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,092.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.75
Rate for Payer: Oxford Commercial	$3,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$3,487.50

STENT PROTEGE 6FR GPS.035

Facility

$6,975.00

Hospital Charge Code	2709002175
Hospital Revenue Code	272
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

STENT PROTEGE 6FR GPS.035 14/6

Facility

$6,975.00

Service Code	HCPCS C2617
Hospital Charge Code	270657494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

STENT PROTEGE 6FR GPS.035 14/6

Facility

$6,975.00

Service Code	HCPCS C2617
Hospital Charge Code	270657494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,092.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

STENT PROTEGE 8x40x120cm

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270638627
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE 8x40x120cm

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270638627
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE 8X40X120CM

Facility

$6,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270638627N
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

STENT PROTEGE 8X40X120CM

Facility

$6,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270638627N
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

STENT PROTEGE 8X40X120CM

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270638627C
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$1,987.44
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE 8X40X120CM

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270638627C
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT PROTEGE EVERFLEX 5x40x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270659312
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE EVERFLEX 5x40x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270659312
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PROTEGE EVERFLEX 6FR

Facility

$6,850.00

Service Code	HCPCS C2617
Hospital Charge Code	270659311
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.50
Max. Negotiated Rate	$1,657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.50

Know your out-of-pocket cost for care.

All Charges