Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT WALLFLEX BILIARY 10x60

Facility

$14,175.00

Hospital Charge Code	270644763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$4,252.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10x60

Facility

$14,175.00

Hospital Charge Code	270644763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10X60MM

Facility

$19,985.00

Service Code	HCPCS C1874
Hospital Charge Code	270648050
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.75
Max. Negotiated Rate	$4,836.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,997.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,836.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,997.75

STENT WALLFLEX BILIARY 10X60MM

Facility

$19,985.00

Service Code	HCPCS C1874
Hospital Charge Code	270648050
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.75
Max. Negotiated Rate	$9,992.50
Rate for Payer: Aetna Commercial	$5,995.50
Rate for Payer: Aetna Medicare Advantage	$5,995.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,096.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,096.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,096.18
Rate for Payer: Cigna Commercial	$9,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,836.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,997.75

STENT WALLFLEX BILIARY 10x80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270677877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$3,899.85
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10x80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270677877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10X80

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270646676N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10X80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270646676C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$3,899.85
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10X80

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270646676N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$4,252.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10X80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270646676C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10x80mm

Facility

$17,250.00

Hospital Charge Code	270642705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$5,175.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

STENT WALLFLEX BILIARY 10x80mm

Facility

$17,250.00

Hospital Charge Code	270642705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

STENT WALLFLEX BILIARY 10x80MM

Facility

$12,995.00

Hospital Charge Code	270646676
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 BILIARY 10x80MM

Facility

$12,995.00

Hospital Charge Code	270646676
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 BILIARY 8x60

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270645387
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 8x60

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270645387
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$4,252.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 8X60

Facility

$14,175.00

Hospital Charge Code	270644971
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 8X60

Facility

$14,175.00

Hospital Charge Code	270644971
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$4,252.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 8x80

Facility

$12,999.50

Service Code	HCPCS C1874
Hospital Charge Code	270677876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 8x80

Facility

$12,999.50

Service Code	HCPCS C1874
Hospital Charge Code	270677876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$3,899.85
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX COLON 22X9CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270643472
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.25
Max. Negotiated Rate	$6,487.50
Rate for Payer: Aetna Commercial	$3,892.50
Rate for Payer: Aetna Medicare Advantage	$3,892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,308.62
Rate for Payer: Cigna Commercial	$6,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25

STENT WALLFLEX COLON 22X9CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270643472
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.25
Max. Negotiated Rate	$3,139.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25

STENT WALLFLEX COLON 25X9CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270662149
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT WALLFLEX COLON 25X9CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270662149
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$3,862.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT WALLFLEX DUODENAL

Facility

$12,300.35

Service Code	HCPCS C1876
Hospital Charge Code	270648010
Hospital Revenue Code	278
Min. Negotiated Rate	$1,845.05
Max. Negotiated Rate	$6,150.18
Rate for Payer: Aetna Commercial	$3,690.11
Rate for Payer: Aetna Medicare Advantage	$3,690.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,136.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,136.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,460.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,136.59
Rate for Payer: Cigna Commercial	$6,150.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,976.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,845.05

Know your out-of-pocket cost for care.

All Charges