Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT SYSTEM 7F 7x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673901
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 7F 7x120MM

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270673901
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 8MM X 57MM

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270659826
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,559.67
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT SYSTEM 8MM X 57MM

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270659826
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT SYSTEM 8MM X 57MM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270659826N
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 SYSTEM 8MM X 57MM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270659826N
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 SYSTEM CENTER 10/3.3 5CM

Facility

$661.15

Hospital Charge Code	270674003
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$330.57
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: Aetna Medicare Advantage	$198.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.59
Rate for Payer: Cigna Commercial	$330.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CENTER 10/3.3 5CM

Facility

$661.15

Hospital Charge Code	270674003
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CENTER 7/3.3 9CM

Facility

$661.15

Hospital Charge Code	270674004
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CENTER 7/3.3 9CM

Facility

$661.15

Hospital Charge Code	270674004
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$330.57
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: Aetna Medicare Advantage	$198.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.59
Rate for Payer: Cigna Commercial	$330.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CTR 10F 3.3MMx9CM

Facility

$661.15

Hospital Charge Code	270672792
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CTR 10F 3.3MMx9CM

Facility

$661.15

Hospital Charge Code	270672792
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$330.57
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: Aetna Medicare Advantage	$198.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.59
Rate for Payer: Cigna Commercial	$330.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CTR 7F 2.3MMx5CM

Facility

$661.15

Hospital Charge Code	270672791
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CTR 7F 2.3MMx5CM

Facility

$661.15

Hospital Charge Code	270672791
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$330.57
Rate for Payer: Aetna Commercial	$198.34
Rate for Payer: Aetna Medicare Advantage	$198.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.59
Rate for Payer: Cigna Commercial	$330.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.17

STENT SYSTEM CTR BEND 7F 12CM

Facility

$651.90

Hospital Charge Code	270675697
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$195.57
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT SYSTEM CTR BEND 7F 12CM

Facility

$651.90

Hospital Charge Code	270675697
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT SYSTEM CTR BEND 7F 15CM

Facility

$651.90

Hospital Charge Code	270675698
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT SYSTEM CTR BEND 7F 15CM

Facility

$651.90

Hospital Charge Code	270675698
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$195.57
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT SYS URETER 8F22cm 24550

Facility

$768.00

Hospital Charge Code	270623953V
Hospital Revenue Code	278
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$185.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.86
Rate for Payer: Qualcare PPO/HMO/WC	$115.20

STENT SYS URETER 8F22cm 24550

Facility

$768.00

Hospital Charge Code	270623953V
Hospital Revenue Code	278
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna Commercial	$230.40
Rate for Payer: Aetna Medicare Advantage	$230.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.84
Rate for Payer: Cigna Commercial	$384.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.86
Rate for Payer: Qualcare PPO/HMO/WC	$115.20

STENT TAX EX 2 75X12 389701227

Facility

$13,625.00

Hospital Charge Code	270637562C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STENT TAX EX 2 75X12 389701227

Facility

$13,635.00

Hospital Charge Code	270638213C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

STENT TAX EX 2 75X12 389701227

Facility

$13,625.00

Hospital Charge Code	270637562C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

STENT TAX EX 2 75X12 389701227

Facility

$13,635.00

Hospital Charge Code	270638213C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$6,817.50
Rate for Payer: Aetna Commercial	$4,090.50
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$6,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

STENT TAX EX 2 75x16 389701627

Facility

$13,625.00

Hospital Charge Code	270637435C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

Know your out-of-pocket cost for care.

All Charges