Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT URETERAL 4.7 Fr./22cm-32

Facility

$295.00

Service Code	HCPCS C2617
Hospital Charge Code	270636831
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT URETERAL 4.7 Fr./22cm-32

Facility

$295.00

Service Code	HCPCS C2617
Hospital Charge Code	270636831
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT URETERAL 4.7FR X 22CM

Facility

$846.35

Service Code	HCPCS C2617
Hospital Charge Code	270661333
Hospital Revenue Code	278
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$423.18
Rate for Payer: Aetna Commercial	$253.91
Rate for Payer: Aetna Medicare Advantage	$253.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.82
Rate for Payer: Cigna Commercial	$423.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.82
Rate for Payer: Qualcare PPO/HMO/WC	$126.95

STENT URETERAL 4.7FR X 22CM

Facility

$846.35

Service Code	HCPCS C2617
Hospital Charge Code	270661333
Hospital Revenue Code	278
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.82
Rate for Payer: Qualcare PPO/HMO/WC	$126.95

STENT URETERAL 6FRX22

Facility

$425.00

Service Code	HCPCS C2617
Hospital Charge Code	270660561
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT URETERAL 6FRX22

Facility

$425.00

Service Code	HCPCS C2617
Hospital Charge Code	270660561
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT URETERAL 7FR 30CM SET

Facility

$816.00

Hospital Charge Code	270331430
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$244.80
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

STENT URETERAL 7FR 30CM SET

Facility

$816.00

Hospital Charge Code	270331430
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

STENT URETERAL 8FR 30CM SET

Facility

$971.00

Hospital Charge Code	270331431
Hospital Revenue Code	278
Min. Negotiated Rate	$145.65
Max. Negotiated Rate	$234.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.98
Rate for Payer: Qualcare PPO/HMO/WC	$145.65

STENT URETERAL 8FR 30CM SET

Facility

$971.00

Hospital Charge Code	270331431
Hospital Revenue Code	278
Min. Negotiated Rate	$145.65
Max. Negotiated Rate	$485.50
Rate for Payer: Aetna Commercial	$291.30
Rate for Payer: Aetna Medicare Advantage	$291.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.60
Rate for Payer: Cigna Commercial	$485.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.98
Rate for Payer: Qualcare PPO/HMO/WC	$145.65

STENT URETERAL CONTOUR 6Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684752
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684752
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684753
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684753
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684754
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684754
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684755
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684755
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684756
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684756
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684757
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684757
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684758
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684758
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$325.80
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 8Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684759
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

Know your out-of-pocket cost for care.

All Charges