Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT VISIPRO 9X57X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270661819
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 9X57X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270661819S
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 9X57X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270661819S
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 9X57X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270661819N
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 9X57X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270661819
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 9X57X80

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270661819N
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 VISI-PRO PXB35-07-37-135

Facility

$4,500.00

Hospital Charge Code	270644830C
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 VISI-PRO PXB35-07-37-135

Facility

$4,500.00

Hospital Charge Code	270644830C
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 WALL 10FR 18x90mm 75cm

Facility

$9,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270678423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$2,700.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

STENT WALL 10FR 18x90mm 75cm

Facility

$9,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270678423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

STENT WALL 18/23X103 M00516900

Facility

$11,750.00

Hospital Charge Code	270641747
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

STENT WALL 18/23X103 M00516900

Facility

$11,750.00

Hospital Charge Code	270641747
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$3,525.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

STENT WALL 18/23X123 M00516910

Facility

$11,750.00

Hospital Charge Code	270641748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$3,525.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

STENT WALL 18/23X123 M00516910

Facility

$11,750.00

Hospital Charge Code	270641748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

STENT WALL 4X40

Facility

$5,250.00

Hospital Charge Code	270627758
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT WALL 4X40

Facility

$5,250.00

Hospital Charge Code	270627758
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT WALL ENDOPROSTHESI 40331

Facility

$5,319.60

Hospital Charge Code	270627282V
Hospital Revenue Code	278
Min. Negotiated Rate	$797.94
Max. Negotiated Rate	$1,287.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,287.34
Rate for Payer: Qualcare PPO/HMO/WC	$797.94

STENT WALL ENDOPROSTHESI 40331

Facility

$5,319.60

Hospital Charge Code	270627282V
Hospital Revenue Code	278
Min. Negotiated Rate	$797.94
Max. Negotiated Rate	$2,659.80
Rate for Payer: Aetna Commercial	$1,595.88
Rate for Payer: Aetna Medicare Advantage	$1,595.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,356.50
Rate for Payer: Cigna Commercial	$2,659.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,287.34
Rate for Payer: Qualcare PPO/HMO/WC	$797.94

STENT WALLFELX BILI 10x40 7052

Facility

$12,995.00

Service Code	HCPCS C1876
Hospital Charge Code	270643124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$3,144.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFELX BILI 10x40 7052

Facility

$12,995.00

Service Code	HCPCS C1876
Hospital Charge Code	270643124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$6,497.50
Rate for Payer: Aetna Commercial	$3,898.50
Rate for Payer: Aetna Medicare Advantage	$3,898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,313.72
Rate for Payer: Cigna Commercial	$6,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFLEX 10MM X 40MM

Facility

$12,995.00

Service Code	HCPCS C1784
Hospital Charge Code	270680142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$6,497.50
Rate for Payer: Aetna Commercial	$3,898.50
Rate for Payer: Aetna Medicare Advantage	$3,898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,313.72
Rate for Payer: Cigna Commercial	$6,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFLEX 10MM X 40MM

Facility

$12,995.00

Service Code	HCPCS C1784
Hospital Charge Code	270680142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$3,144.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFLEX 10x40

Facility

$14,995.00

Hospital Charge Code	270648051
Hospital Revenue Code	278
Min. Negotiated Rate	$2,249.25
Max. Negotiated Rate	$3,628.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25

STENT WALLFLEX 10x40

Facility

$14,995.00

Hospital Charge Code	270648051
Hospital Revenue Code	278
Min. Negotiated Rate	$2,249.25
Max. Negotiated Rate	$7,497.50
Rate for Payer: Aetna Commercial	$4,498.50
Rate for Payer: Aetna Medicare Advantage	$4,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,823.72
Rate for Payer: Cigna Commercial	$7,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25

STENT WALLFLEX 10X40

Facility

$14,995.00

Hospital Charge Code	270648051C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,249.25
Max. Negotiated Rate	$7,497.50
Rate for Payer: Aetna Commercial	$4,498.50
Rate for Payer: Aetna Medicare Advantage	$4,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,823.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,823.72
Rate for Payer: Cigna Commercial	$7,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,249.25

Know your out-of-pocket cost for care.

All Charges