Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABAHN .014 6MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690860
Hospital Revenue Code	278
Min. Negotiated Rate	$5,426.25
Max. Negotiated Rate	$8,754.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25

STENT VIABAHN .014 6MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690860
Hospital Revenue Code	278
Min. Negotiated Rate	$5,426.25
Max. Negotiated Rate	$18,087.50
Rate for Payer: Aetna Commercial	$10,852.50
Rate for Payer: Aetna Medicare Advantage	$10,852.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,224.62
Rate for Payer: Cigna Commercial	$18,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25

STENT VIABAHN .014 7MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690861
Hospital Revenue Code	278
Min. Negotiated Rate	$5,426.25
Max. Negotiated Rate	$18,087.50
Rate for Payer: Aetna Commercial	$10,852.50
Rate for Payer: Aetna Medicare Advantage	$10,852.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,224.62
Rate for Payer: Cigna Commercial	$18,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25

STENT VIABAHN .014 7MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690861
Hospital Revenue Code	278
Min. Negotiated Rate	$5,426.25
Max. Negotiated Rate	$8,754.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25

STENT VIABAHN 13MM 10CM 75CM

Facility

$24,242.84

Hospital Charge Code	270636760
Hospital Revenue Code	278
Min. Negotiated Rate	$3,636.43
Max. Negotiated Rate	$12,121.42
Rate for Payer: Aetna Commercial	$7,272.85
Rate for Payer: Aetna Medicare Advantage	$7,272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,848.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,181.92
Rate for Payer: Cigna Commercial	$12,121.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,866.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,636.43

STENT VIABAHN 13MM 10CM 75CM

Facility

$24,242.84

Hospital Charge Code	270636760
Hospital Revenue Code	278
Min. Negotiated Rate	$3,636.43
Max. Negotiated Rate	$5,866.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,848.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,866.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,636.43

STENT VIABAHN 35 RO 8MM X 7.6

Facility

$19,230.00

Hospital Charge Code	270689581
Hospital Revenue Code	272
Min. Negotiated Rate	$2,499.90
Max. Negotiated Rate	$9,615.00
Rate for Payer: Aetna Commercial	$5,769.00
Rate for Payer: Aetna Medicare Advantage	$5,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,903.65
Rate for Payer: Cigna Commercial	$9,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,499.90
Rate for Payer: Oxford Commercial	$9,615.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50
Rate for Payer: UnitedHealthcare Commercial	$9,615.00

STENT VIABAHN 35 RO 8MM X 7.6

Facility

$19,230.00

Hospital Charge Code	270689581
Hospital Revenue Code	272
Min. Negotiated Rate	$2,884.50
Max. Negotiated Rate	$2,884.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50

STENT VIABAHN 35 X 13 MM 10 CM

Facility

$18,760.00

Service Code	HCPCS C1876
Hospital Charge Code	270688211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$4,539.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,539.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,814.00

STENT VIABAHN 35 X 13 MM 10 CM

Facility

$18,760.00

Service Code	HCPCS C1876
Hospital Charge Code	270688211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$9,380.00
Rate for Payer: Aetna Commercial	$5,628.00
Rate for Payer: Aetna Medicare Advantage	$5,628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,783.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,783.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,783.80
Rate for Payer: Cigna Commercial	$9,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,539.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,814.00

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.00
Max. Negotiated Rate	$8,380.00
Rate for Payer: Aetna Commercial	$5,028.00
Rate for Payer: Aetna Medicare Advantage	$5,028.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,273.80
Rate for Payer: Cigna Commercial	$8,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.00
Max. Negotiated Rate	$4,055.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.00
Max. Negotiated Rate	$4,055.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.00
Max. Negotiated Rate	$8,380.00
Rate for Payer: Aetna Commercial	$5,028.00
Rate for Payer: Aetna Medicare Advantage	$5,028.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,273.80
Rate for Payer: Cigna Commercial	$8,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$9,660.00
Rate for Payer: Aetna Commercial	$5,796.00
Rate for Payer: Aetna Medicare Advantage	$5,796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,926.60
Rate for Payer: Cigna Commercial	$9,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$4,675.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$4,675.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$9,660.00
Rate for Payer: Aetna Commercial	$5,796.00
Rate for Payer: Aetna Medicare Advantage	$5,796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,926.60
Rate for Payer: Cigna Commercial	$9,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VIABAHN 6MM 10x120CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.50
Max. Negotiated Rate	$4,663.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50

STENT VIABAHN 6MM 10x120CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.50
Max. Negotiated Rate	$9,635.00
Rate for Payer: Aetna Commercial	$5,781.00
Rate for Payer: Aetna Medicare Advantage	$5,781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,913.85
Rate for Payer: Cigna Commercial	$9,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50

STENT VIABAHN 6MM 10x120CM

Facility

$17,900.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,685.00
Max. Negotiated Rate	$8,950.00
Rate for Payer: Aetna Commercial	$5,370.00
Rate for Payer: Aetna Medicare Advantage	$5,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,564.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,564.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,564.50
Rate for Payer: Cigna Commercial	$8,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,331.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,685.00

STENT VIABAHN 6MM 10x120CM

Facility

$17,900.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,685.00
Max. Negotiated Rate	$4,331.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,331.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,685.00

STENT VIABAHN 6MM 15x120CM

Facility

$19,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.50
Max. Negotiated Rate	$9,975.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$5,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,087.25
Rate for Payer: Cigna Commercial	$9,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,827.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,992.50

STENT VIABAHN 6MM 15x120CM

Facility

$20,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639
Hospital Revenue Code	278
Min. Negotiated Rate	$3,142.50
Max. Negotiated Rate	$5,069.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,142.50

STENT VIABAHN 6MM 15x120CM

Facility

$19,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.50
Max. Negotiated Rate	$4,827.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,827.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,992.50

Know your out-of-pocket cost for care.

All Charges