Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT URETERAL VL 6F 22-30 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270689651
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETERAL VL 6F 22-30 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270689651
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$348.86
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETERAL WIRE 4.7F 22-32

Facility

$319.15

Service Code	HCPCS C2617
Hospital Charge Code	270696691
Hospital Revenue Code	278
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$159.57
Rate for Payer: Aetna Commercial	$95.75
Rate for Payer: Aetna Medicare Advantage	$95.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.38
Rate for Payer: Cigna Commercial	$159.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.87

STENT URETERAL WIRE 4.7F 22-32

Facility

$319.15

Service Code	HCPCS C2617
Hospital Charge Code	270696691
Hospital Revenue Code	278
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$77.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.87

STENT URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595S
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595N
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595N
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595S
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595
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 URETER PERCUFLEX 6FX24CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696158
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETER PERCUFLEX 6FX24CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696158
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$348.86
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETH 3.0 UROLME 7240201

Facility

$13,020.00

Hospital Charge Code	270932705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$6,510.00
Rate for Payer: Aetna Commercial	$3,906.00
Rate for Payer: Aetna Medicare Advantage	$3,906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,320.10
Rate for Payer: Cigna Commercial	$6,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00

STENT URETH 3.0 UROLME 7240201

Facility

$10,416.00

Hospital Charge Code	270632705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.40
Max. Negotiated Rate	$5,208.00
Rate for Payer: Aetna Commercial	$3,124.80
Rate for Payer: Aetna Medicare Advantage	$3,124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,656.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,656.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,656.08
Rate for Payer: Cigna Commercial	$5,208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.40

STENT URETH 3.0 UROLME 7240201

Facility

$10,416.00

Hospital Charge Code	270632705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.40
Max. Negotiated Rate	$2,520.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.40

STENT URETH 3.0 UROLME 7240201

Facility

$13,020.00

Hospital Charge Code	270932705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$3,150.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00

STENT URETHERAL 4.7FR 24CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660098
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$423.15
Rate for Payer: Aetna Commercial	$253.89
Rate for Payer: Aetna Medicare Advantage	$253.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.81
Rate for Payer: Cigna Commercial	$423.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENT URETHERAL 4.7FR 24CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660098
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$204.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENT URETHERAL 4.7FR 26CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660099
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$423.15
Rate for Payer: Aetna Commercial	$253.89
Rate for Payer: Aetna Medicare Advantage	$253.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.81
Rate for Payer: Cigna Commercial	$423.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENT URETHERAL 4.7FR 26CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660099
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$204.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENTURETPERCUFL6F2.0MMX26CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696159
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENTURETPERCUFL6F2.0MMX26CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696159
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$348.86
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URET PGTL 4.7 25 039525

Facility

$920.00

Hospital Charge Code	270601233
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$222.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

STENT URET PGTL 4.7 25 039525

Facility

$920.00

Hospital Charge Code	270601233
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$276.00
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

STENT URET PGTL 5 24CM 031524

Facility

$436.50

Service Code	HCPCS C2617
Hospital Charge Code	270601228
Hospital Revenue Code	278
Min. Negotiated Rate	$65.47
Max. Negotiated Rate	$218.25
Rate for Payer: Aetna Commercial	$130.95
Rate for Payer: Aetna Medicare Advantage	$130.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.31
Rate for Payer: Cigna Commercial	$218.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.63
Rate for Payer: Qualcare PPO/HMO/WC	$65.47

Know your out-of-pocket cost for care.

All Charges