Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$5,625.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$5,625.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8mmX59mmx135mm

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 8mmX59mmx135mm

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$5,004.00
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$4,882.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$4,882.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

STENT VIABAHN 8x15cm

Facility

$18,975.00

Hospital Charge Code	270671133
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$5,692.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN 8x15cm

Facility

$18,975.00

Hospital Charge Code	270671133
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN 8x39MM 135CM

Facility

$19,235.00

Service Code	HCPCS C1874
Hospital Charge Code	270699839S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,885.25
Max. Negotiated Rate	$9,617.50
Rate for Payer: Aetna Commercial	$5,770.50
Rate for Payer: Aetna Medicare Advantage	$5,770.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,904.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,904.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,904.93
Rate for Payer: Cigna Commercial	$9,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,654.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,885.25

STENT VIABAHN 8x39MM 135CM

Facility

$19,235.00

Service Code	HCPCS C1874
Hospital Charge Code	270699839S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,885.25
Max. Negotiated Rate	$4,654.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,654.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,885.25

STENT VIABAHN 8X5 VBA080502

Facility

$24,242.84

Hospital Charge Code	270633179
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 8X5 VBA080502

Facility

$24,242.84

Hospital Charge Code	270633179
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 8x5x75 VBA080501

Facility

$10,168.00

Hospital Charge Code	270633717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$2,460.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT VIABAHN 8x5x75 VBA080501

Facility

$24,242.84

Hospital Charge Code	270633717V
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 8x5x75 VBA080501

Facility

$24,242.84

Hospital Charge Code	270633717V
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 8x5x75 VBA080501

Facility

$10,168.00

Hospital Charge Code	270633717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.20
Max. Negotiated Rate	$5,084.00
Rate for Payer: Aetna Commercial	$3,050.40
Rate for Payer: Aetna Medicare Advantage	$3,050.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,592.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,033.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,592.84
Rate for Payer: Cigna Commercial	$5,084.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.20

STENT VIABAHN 9FR 9x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669522
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN 9FR 9x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669522
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$5,692.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN 9x15cm

Facility

$18,975.00

Hospital Charge Code	270671134
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN 9x15cm

Facility

$18,975.00

Hospital Charge Code	270671134
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$5,692.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

STENT VIABAHN ENDOPRO 7MMx10CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270676102
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

Know your out-of-pocket cost for care.

All Charges