Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$105.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.63
Rate for Payer: Qualcare PPO/HMO/WC	$65.47

STENT URET PGTL 5 25CM 031525

Facility

$1,104.85

Hospital Charge Code	270601230
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$331.45
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

STENT URET PGTL 5 25CM 031525

Facility

$1,104.85

Hospital Charge Code	270601230
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$267.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

STENT URET PGTL 5 25CM 031525T

Facility

$1,104.85

Hospital Charge Code	270611475
Hospital Revenue Code	272
Min. Negotiated Rate	$143.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$331.45
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.63
Rate for Payer: Oxford Commercial	$552.42
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Commercial	$552.42

STENT URET PGTL 5 25CM 031525T

Facility

$1,104.85

Hospital Charge Code	270611475
Hospital Revenue Code	272
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$165.73
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

STENT URET PGTL 5 27CM 031527

Facility

$920.00

Hospital Charge Code	270601231
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 5 27CM 031527

Facility

$920.00

Hospital Charge Code	270601231
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 6 22 060022AQ

Facility

$851.25

Hospital Charge Code	270619379
Hospital Revenue Code	278
Min. Negotiated Rate	$127.69
Max. Negotiated Rate	$206.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.69

STENT URET PGTL 6 22 060022AQ

Facility

$851.25

Hospital Charge Code	270619379
Hospital Revenue Code	278
Min. Negotiated Rate	$127.69
Max. Negotiated Rate	$425.62
Rate for Payer: Aetna Commercial	$255.38
Rate for Payer: Aetna Medicare Advantage	$255.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.07
Rate for Payer: Cigna Commercial	$425.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.69

STENT URET PGTL 6 22 335682

Facility

$775.25

Hospital Charge Code	270615981
Hospital Revenue Code	278
Min. Negotiated Rate	$116.29
Max. Negotiated Rate	$387.62
Rate for Payer: Aetna Commercial	$232.57
Rate for Payer: Aetna Medicare Advantage	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.69
Rate for Payer: Cigna Commercial	$387.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.29

STENT URET PGTL 6 22 335682

Facility

$775.25

Hospital Charge Code	270615981
Hospital Revenue Code	278
Min. Negotiated Rate	$116.29
Max. Negotiated Rate	$187.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.29

STENT URET PGTL 6 22CM 036622

Facility

$670.45

Hospital Charge Code	270618732
Hospital Revenue Code	278
Min. Negotiated Rate	$100.57
Max. Negotiated Rate	$162.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.25
Rate for Payer: Qualcare PPO/HMO/WC	$100.57

STENT URET PGTL 6 22CM 036622

Facility

$670.45

Hospital Charge Code	270618732
Hospital Revenue Code	278
Min. Negotiated Rate	$100.57
Max. Negotiated Rate	$335.23
Rate for Payer: Aetna Commercial	$201.13
Rate for Payer: Aetna Medicare Advantage	$201.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.96
Rate for Payer: Cigna Commercial	$335.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.25
Rate for Payer: Qualcare PPO/HMO/WC	$100.57

STENT URET PGTL 6 24 060024AQ

Facility

$851.25

Hospital Charge Code	270619391
Hospital Revenue Code	278
Min. Negotiated Rate	$127.69
Max. Negotiated Rate	$425.62
Rate for Payer: Aetna Commercial	$255.38
Rate for Payer: Aetna Medicare Advantage	$255.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.07
Rate for Payer: Cigna Commercial	$425.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.69

STENT URET PGTL 6 24 060024AQ

Facility

$851.25

Hospital Charge Code	270619391
Hospital Revenue Code	278
Min. Negotiated Rate	$127.69
Max. Negotiated Rate	$206.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.69

STENT URET PGTL 6 24CM 036624

Facility

$671.25

Hospital Charge Code	270618733
Hospital Revenue Code	278
Min. Negotiated Rate	$100.69
Max. Negotiated Rate	$335.62
Rate for Payer: Aetna Commercial	$201.38
Rate for Payer: Aetna Medicare Advantage	$201.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.17
Rate for Payer: Cigna Commercial	$335.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.44
Rate for Payer: Qualcare PPO/HMO/WC	$100.69

STENT URET PGTL 6 24CM 036624

Facility

$671.25

Hospital Charge Code	270618733
Hospital Revenue Code	278
Min. Negotiated Rate	$100.69
Max. Negotiated Rate	$162.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.44
Rate for Payer: Qualcare PPO/HMO/WC	$100.69

STENT URET PGTL 6 26 060026AQ

Facility

$856.00

Hospital Charge Code	270619898
Hospital Revenue Code	278
Min. Negotiated Rate	$128.40
Max. Negotiated Rate	$428.00
Rate for Payer: Aetna Commercial	$256.80
Rate for Payer: Aetna Medicare Advantage	$256.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.28
Rate for Payer: Cigna Commercial	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.15
Rate for Payer: Qualcare PPO/HMO/WC	$128.40

STENT URET PGTL 6 26 060026AQ

Facility

$856.00

Hospital Charge Code	270619898
Hospital Revenue Code	278
Min. Negotiated Rate	$128.40
Max. Negotiated Rate	$207.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.15
Rate for Payer: Qualcare PPO/HMO/WC	$128.40

STENT URET PGTL 6 26CM 036626

Facility

$668.00

Hospital Charge Code	270618734
Hospital Revenue Code	278
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$200.40
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.66
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

STENT URET PGTL 6 26CM 036626

Facility

$668.00

Hospital Charge Code	270618734
Hospital Revenue Code	278
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$161.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.66
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

STENT URET PGTL 7 25CM 031725

Facility

$920.00

Hospital Charge Code	270601229
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 7 25CM 031725

Facility

$920.00

Hospital Charge Code	270601229
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 7 27CM 031727

Facility

$920.00

Hospital Charge Code	270601232
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 7 27CM 031727

Facility

$920.00

Hospital Charge Code	270601232
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

Know your out-of-pocket cost for care.

All Charges