Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 8Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684760
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 8Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684760
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 8Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684761
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 8Fx26cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684761
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 8Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684762
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 8Fx28cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684762
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 8Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684763
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 8Fx30cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684763
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 INLAY 22-32CM

Facility

$429.05

Service Code	HCPCS C2625
Hospital Charge Code	270689491
Hospital Revenue Code	278
Min. Negotiated Rate	$64.36
Max. Negotiated Rate	$103.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.83
Rate for Payer: Qualcare PPO/HMO/WC	$64.36

STENT URETERAL INLAY 22-32CM

Facility

$429.05

Service Code	HCPCS C2625
Hospital Charge Code	270689491
Hospital Revenue Code	278
Min. Negotiated Rate	$64.36
Max. Negotiated Rate	$214.53
Rate for Payer: Aetna Commercial	$128.72
Rate for Payer: Aetna Medicare Advantage	$128.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.41
Rate for Payer: Cigna Commercial	$214.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.83
Rate for Payer: Qualcare PPO/HMO/WC	$64.36

STENT URETERAL OPTIMA 7FR 24CM

Facility

$0.05

Service Code	HCPCS C2617FB
Hospital Charge Code	270700827
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

STENT URETERAL OPTIMA 7FR 24CM

Facility

$0.05

Service Code	HCPCS C2617FB
Hospital Charge Code	270700827
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

STENT URETERAL SET

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270658504
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$210.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

STENT URETERAL SET

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270658504
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

STENT URETERAL SOFT 5FR 22CM

Facility

$493.25

Hospital Charge Code	270657637
Hospital Revenue Code	278
Min. Negotiated Rate	$73.99
Max. Negotiated Rate	$119.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.37
Rate for Payer: Qualcare PPO/HMO/WC	$73.99

STENT URETERAL SOFT 5FR 22CM

Facility

$493.25

Hospital Charge Code	270657637
Hospital Revenue Code	278
Min. Negotiated Rate	$73.99
Max. Negotiated Rate	$246.62
Rate for Payer: Aetna Commercial	$147.97
Rate for Payer: Aetna Medicare Advantage	$147.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.78
Rate for Payer: Cigna Commercial	$246.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.37
Rate for Payer: Qualcare PPO/HMO/WC	$73.99

STENT URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658590
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 URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658589
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 SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658590
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 SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658589
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 URETERAL SOFT 7.0FR 22CM

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658588
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$98.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT URETERAL SOFT 7.0FR 22CM

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658588
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$203.12
Rate for Payer: Aetna Commercial	$121.88
Rate for Payer: Aetna Medicare Advantage	$121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.59
Rate for Payer: Cigna Commercial	$203.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT URETERAL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658594
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 SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658594
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

Know your out-of-pocket cost for care.

All Charges