Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT VISION RX 3.0 X 15

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643615
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT VISION RX 3.5 X 12

Facility

$3,450.00

Hospital Charge Code	270643620
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,035.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT VISION RX 3.5 X 12

Facility

$3,450.00

Hospital Charge Code	2709001108
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT VISION RX 3.5 X 12

Facility

$3,450.00

Hospital Charge Code	270643620
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$834.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

STENT VISION RX 3.5 X 12

Facility

$3,450.00

Hospital Charge Code	2709001108
Hospital Revenue Code	272
Min. Negotiated Rate	$448.50
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,035.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.50
Rate for Payer: Oxford Commercial	$1,725.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$1,725.00

STENT VISIPR 8X27 PXB350827135

Facility

$6,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270643692N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.75
Max. Negotiated Rate	$1,651.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,023.75

STENT VISIPR 8X27 PXB350827135

Facility

$6,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270643692N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.75
Max. Negotiated Rate	$3,412.50
Rate for Payer: Cigna Commercial	$3,412.50
Rate for Payer: Aetna Commercial	$2,047.50
Rate for Payer: Aetna Medicare Advantage	$2,047.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,740.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,740.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,740.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,023.75

STENT VISIPR 8X27 PXB350827135

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270643692C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 8X27 PXB350827135

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270643692C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 8X37 PXB350837135

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270644834C
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT VISIPR 8X37 PXB350837135

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644834N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 8X37 PXB350837135

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644834N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 8X37 PXB350837135

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270644834C
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,559.67
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

STENT VISIPR 8X57X PXB35085713

Facility

$4,500.00

Hospital Charge Code	270644836C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 8X57X PXB35085713

Facility

$4,500.00

Hospital Charge Code	270644836C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 9X37 PXB350937135

Facility

$4,500.00

Hospital Charge Code	270644540C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPR 9X37 PXB350937135

Facility

$4,500.00

Hospital Charge Code	270644540C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x17x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673708N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x17x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673708N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x17x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673708
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x17x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673708
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x27x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673709N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x27x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673709
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x27x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673709
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT VISIPRO 10x27x80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270673709N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

Know your out-of-pocket cost for care.

All Charges