Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT TX XPEDITION 2.75X18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658768
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 ULTRAFLEX TRACH 18X80MM

Facility

$16,500.00

Hospital Charge Code	270671168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT ULTRAFLEX TRACH 18X80MM

Facility

$16,500.00

Hospital Charge Code	270671168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$4,950.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270667714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.50
Max. Negotiated Rate	$6,065.00
Rate for Payer: Aetna Commercial	$3,639.00
Rate for Payer: Aetna Medicare Advantage	$3,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,093.15
Rate for Payer: Cigna Commercial	$6,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270665628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.50
Max. Negotiated Rate	$6,065.00
Rate for Payer: Aetna Commercial	$3,639.00
Rate for Payer: Aetna Medicare Advantage	$3,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,093.15
Rate for Payer: Cigna Commercial	$6,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270667714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.50
Max. Negotiated Rate	$2,935.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50

STENT ULTRAFLEX TRACHEOBRONCHI

Facility

$12,130.00

Hospital Charge Code	270665628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.50
Max. Negotiated Rate	$2,935.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,935.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.50

STENT UNCOVERED BILIARY 8x10

Facility

$8,504.25

Service Code	HCPCS C1876
Hospital Charge Code	270677074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.64
Max. Negotiated Rate	$4,252.12
Rate for Payer: Aetna Commercial	$2,551.28
Rate for Payer: Aetna Medicare Advantage	$2,551.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,168.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,168.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,168.58
Rate for Payer: Cigna Commercial	$4,252.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.64

STENT UNCOVERED BILIARY 8x10

Facility

$8,504.25

Service Code	HCPCS C1876
Hospital Charge Code	270677074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.64
Max. Negotiated Rate	$2,058.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.64

STENT UNIVERSA FIRM 6x22

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647871
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x22

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647871
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x26

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647873
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x26

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647873
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x28

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647874
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x28

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647874
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 5FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647869
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 5FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647869
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6 24

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647872
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6 24

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647872
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647870
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647870
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT7 FR22-32cm

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658545
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT7 FR22-32cm

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658545
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$135.72
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT, URETERAL

Facility

$924.00

Hospital Charge Code	2008165
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$462.00
Rate for Payer: Aetna Commercial	$277.20
Rate for Payer: Aetna Medicare Advantage	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.62
Rate for Payer: Cigna Commercial	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.61
Rate for Payer: Qualcare PPO/HMO/WC	$138.60

STENT, URETERAL

Facility

$924.00

Hospital Charge Code	2008165
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$223.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.61
Rate for Payer: Qualcare PPO/HMO/WC	$138.60

Know your out-of-pocket cost for care.

All Charges