Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265
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 SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265S
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 SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265N
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 SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265
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 SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265N
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 SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265O
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 SUPRA 5.5 60 MM

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270668265S
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 SUPREA 5X120 S05120120G2

Facility

$15,000.00

Hospital Charge Code	270644138V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT SUPREA 5X120 S05120120G2

Facility

$15,000.00

Hospital Charge Code	270644138V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,552.10

Hospital Charge Code	270626880
Hospital Revenue Code	278
Min. Negotiated Rate	$832.82
Max. Negotiated Rate	$1,343.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.61
Rate for Payer: Qualcare PPO/HMO/WC	$832.82

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,596.80

Hospital Charge Code	270626880V
Hospital Revenue Code	278
Min. Negotiated Rate	$839.52
Max. Negotiated Rate	$2,798.40
Rate for Payer: Aetna Commercial	$1,679.04
Rate for Payer: Aetna Medicare Advantage	$1,679.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,427.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,427.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,119.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,427.18
Rate for Payer: Cigna Commercial	$2,798.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,354.43
Rate for Payer: Qualcare PPO/HMO/WC	$839.52

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,552.10

Hospital Charge Code	270626880
Hospital Revenue Code	278
Min. Negotiated Rate	$832.82
Max. Negotiated Rate	$2,776.05
Rate for Payer: Aetna Commercial	$1,665.63
Rate for Payer: Aetna Medicare Advantage	$1,665.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.79
Rate for Payer: Cigna Commercial	$2,776.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.61
Rate for Payer: Qualcare PPO/HMO/WC	$832.82

STENT SYMPHY 7F 14x40x75 60362

Facility

$5,596.80

Hospital Charge Code	270626880V
Hospital Revenue Code	278
Min. Negotiated Rate	$839.52
Max. Negotiated Rate	$1,354.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,119.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,354.43
Rate for Payer: Qualcare PPO/HMO/WC	$839.52

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,050.40
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,050.40
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT SYS ACLINK CAR 101134030

Facility

$10,168.00

Hospital Charge Code	270635100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT SYSTEM 6F 6x100MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672788
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$1,612.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x100MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672788
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672787
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270672787
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$1,612.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270669992
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 6F 6x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270669992
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$1,612.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 75CM SHAFT 8x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673632
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$1,612.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT SYSTEM 75CM SHAFT 8x40MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673632
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

Know your out-of-pocket cost for care.

All Charges