Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT RX XPEDITION 3 50x33

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658795S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 3 50x33

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 3 50x33

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658795S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x08

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x08

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x28

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658802
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x28

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658802
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x33

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666074S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x33

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666074S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x33

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x33

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x33

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666074N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPEDITION 4.0x33

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270666074N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658774S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658774S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT SELFE 6x40x120 NT356402D

Facility

$8,375.00

Hospital Charge Code	270637017V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.25
Max. Negotiated Rate	$4,187.50
Rate for Payer: Aetna Commercial	$2,512.50
Rate for Payer: Aetna Medicare Advantage	$2,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,135.62
Rate for Payer: Cigna Commercial	$4,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25

STENT SELFE 6x40x120 NT356402D

Facility

$8,375.00

Hospital Charge Code	270637017V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.25
Max. Negotiated Rate	$2,026.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25

STENT SELFE 8x90x120 NT358902D

Facility

$10,075.00

Hospital Charge Code	270637022V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.25
Max. Negotiated Rate	$2,438.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,438.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,511.25

STENT SELFE 8x90x120 NT358902D

Facility

$10,075.00

Hospital Charge Code	270637022V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.25
Max. Negotiated Rate	$5,037.50
Rate for Payer: Aetna Commercial	$3,022.50
Rate for Payer: Aetna Medicare Advantage	$3,022.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,569.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,569.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,569.12
Rate for Payer: Cigna Commercial	$5,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,438.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,511.25

STENT SELFEX 8x40 75 NT358401D

Facility

$8,375.00

Hospital Charge Code	270637052
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.25
Max. Negotiated Rate	$2,026.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25

STENT SELFEX 8x40 75 NT358401D

Facility

$8,375.00

Hospital Charge Code	270637052
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.25
Max. Negotiated Rate	$4,187.50
Rate for Payer: Aetna Commercial	$2,512.50
Rate for Payer: Aetna Medicare Advantage	$2,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,135.62
Rate for Payer: Cigna Commercial	$4,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25

Know your out-of-pocket cost for care.

All Charges