Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT URET PRCFLX 6X24 175-262

Facility

$1,073.65

Service Code	HCPCS C2617
Hospital Charge Code	270616190
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$322.10
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT URET PRCFLX 6X24 175-262

Facility

$1,073.65

Service Code	HCPCS C2617
Hospital Charge Code	270616190
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$259.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT URET PRCFLX 7X26 175-273

Facility

$1,073.65

Hospital Charge Code	270616492
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$322.10
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT URET PRCFLX 7X26 175-273

Facility

$1,073.65

Hospital Charge Code	270616492
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$259.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT VAIBAHN 8MMX5CMX120CM

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

STENT VAIBAHN 8MMX5CMX120CM

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$5,284.50
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

STENT VARIABLE LENGTH 48FR

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270650849
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 VARIABLE LENGTH 48FR

Facility

$700.00

Service Code	HCPCS C2617
Hospital Charge Code	270650849
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 VARIABLE LENGTH 7FR

Facility

$700.00

Hospital Charge Code	270650850
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 VARIABLE LENGTH 7FR

Facility

$700.00

Hospital Charge Code	270650850
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 VASCULAR FREDX21 3X13MM

Facility

$86,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270700648S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,990.00
Max. Negotiated Rate	$43,300.00
Rate for Payer: Aetna Commercial	$25,980.00
Rate for Payer: Aetna Medicare Advantage	$25,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,083.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,083.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,083.00
Rate for Payer: Cigna Commercial	$43,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,957.20
Rate for Payer: Qualcare PPO/HMO/WC	$12,990.00

STENT VASCULAR FREDX21 3X13MM

Facility

$86,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270700648S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,990.00
Max. Negotiated Rate	$20,957.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,957.20
Rate for Payer: Qualcare PPO/HMO/WC	$12,990.00

STENT VASCULAR ZILVER 518

Facility

$8,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270662856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT VASCULAR ZILVER 518

Facility

$8,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270662856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT VBX ENDOPROS 11 X 79 CM

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$4,136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

STENT VBX ENDOPROS 11 X 79 CM

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$8,547.50
Rate for Payer: Aetna Commercial	$5,128.50
Rate for Payer: Aetna Medicare Advantage	$5,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.23
Rate for Payer: Cigna Commercial	$8,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

STENT VERIFLEX 12mm 3.50

Facility

$6,250.00

Hospital Charge Code	270638315
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 12mm 3.50

Facility

$6,250.00

Hospital Charge Code	270638315
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 12mm 4.00

Facility

$6,250.00

Hospital Charge Code	270638226
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 12mm 4.00

Facility

$6,250.00

Hospital Charge Code	270638226
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 24mm 3.00

Facility

$6,250.00

Hospital Charge Code	270659110
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 24mm 3.00

Facility

$6,250.00

Hospital Charge Code	270659110
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 32mm 4.00

Facility

$6,250.00

Hospital Charge Code	270CH0081
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 32mm 4.00

Facility

$6,250.00

Hospital Charge Code	270CH0081
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

STENT VERIFLEX 32mm 4.50

Facility

$6,250.00

Hospital Charge Code	270CH0082
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

Know your out-of-pocket cost for care.

All Charges