Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$2,976.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,460.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,976.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,845.05

STENT--WALLFLEX ESOPHAGEAL18MM

Facility

$11,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270680058
Hospital Revenue Code	278
Min. Negotiated Rate	$1,799.25
Max. Negotiated Rate	$2,902.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,902.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,799.25

STENT--WALLFLEX ESOPHAGEAL18MM

Facility

$11,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270680058
Hospital Revenue Code	278
Min. Negotiated Rate	$1,799.25
Max. Negotiated Rate	$5,997.50
Rate for Payer: Aetna Commercial	$3,598.50
Rate for Payer: Aetna Medicare Advantage	$3,598.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,058.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,058.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,058.72
Rate for Payer: Cigna Commercial	$5,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,902.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,799.25

STENT WALLFX 27/22X12 230 6512

Facility

$12,975.00

Hospital Charge Code	270644083
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 WALLFX 27/22X12 230 6512

Facility

$12,975.00

Hospital Charge Code	270644083
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 WALLGRAFT 10x50

Facility

$10,265.00

Hospital Charge Code	270623517
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$5,132.50
Rate for Payer: Aetna Commercial	$3,079.50
Rate for Payer: Aetna Medicare Advantage	$3,079.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,617.57
Rate for Payer: Cigna Commercial	$5,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALLGRAFT 10x50

Facility

$10,265.00

Hospital Charge Code	270623517
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$2,484.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALLGRAFT 12x50

Facility

$10,265.00

Hospital Charge Code	270623518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$5,132.50
Rate for Payer: Aetna Commercial	$3,079.50
Rate for Payer: Aetna Medicare Advantage	$3,079.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,617.57
Rate for Payer: Cigna Commercial	$5,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALLGRAFT 12x50

Facility

$10,265.00

Hospital Charge Code	270623518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$2,484.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALLGRAFT 8x50

Facility

$10,265.00

Hospital Charge Code	270623516
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$2,484.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALLGRAFT 8x50

Facility

$10,265.00

Hospital Charge Code	270623516
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.75
Max. Negotiated Rate	$5,132.50
Rate for Payer: Aetna Commercial	$3,079.50
Rate for Payer: Aetna Medicare Advantage	$3,079.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,617.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,617.57
Rate for Payer: Cigna Commercial	$5,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,484.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,539.75

STENT WALL RAPID EXCHANGE 6971

Facility

$7,936.00

Hospital Charge Code	270630294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,190.40
Max. Negotiated Rate	$1,920.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,587.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,920.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,190.40

STENT WALL RAPID EXCHANGE 6971

Facility

$7,936.00

Hospital Charge Code	270630294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,190.40
Max. Negotiated Rate	$3,968.00
Rate for Payer: Aetna Commercial	$2,380.80
Rate for Payer: Aetna Medicare Advantage	$2,380.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,587.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,023.68
Rate for Payer: Cigna Commercial	$3,968.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,920.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,190.40

STENT WALLSTENT 8F 100cm 4021

Facility

$5,193.40

Hospital Charge Code	270624175V
Hospital Revenue Code	278
Min. Negotiated Rate	$779.01
Max. Negotiated Rate	$1,256.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,038.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,256.80
Rate for Payer: Qualcare PPO/HMO/WC	$779.01

STENT WALLSTENT 8F 100cm 4021

Facility

$5,193.40

Hospital Charge Code	270624175V
Hospital Revenue Code	278
Min. Negotiated Rate	$779.01
Max. Negotiated Rate	$2,596.70
Rate for Payer: Aetna Commercial	$1,558.02
Rate for Payer: Aetna Medicare Advantage	$1,558.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,038.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.32
Rate for Payer: Cigna Commercial	$2,596.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,256.80
Rate for Payer: Qualcare PPO/HMO/WC	$779.01

STENT WALLSTENT 8F 100cm 40211

Facility

$5,152.00

Hospital Charge Code	270624175
Hospital Revenue Code	278
Min. Negotiated Rate	$772.80
Max. Negotiated Rate	$2,576.00
Rate for Payer: Aetna Commercial	$1,545.60
Rate for Payer: Aetna Medicare Advantage	$1,545.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.76
Rate for Payer: Cigna Commercial	$2,576.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.78
Rate for Payer: Qualcare PPO/HMO/WC	$772.80

STENT WALLSTENT 8F 100cm 40211

Facility

$5,152.00

Hospital Charge Code	270624175
Hospital Revenue Code	278
Min. Negotiated Rate	$772.80
Max. Negotiated Rate	$1,246.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.78
Rate for Payer: Qualcare PPO/HMO/WC	$772.80

STENT WALL WPERLUME 10x80 6972

Facility

$7,675.00

Hospital Charge Code	270637764
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$3,837.50
Rate for Payer: Aetna Commercial	$2,302.50
Rate for Payer: Aetna Medicare Advantage	$2,302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.12
Rate for Payer: Cigna Commercial	$3,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

STENT WALL WPERLUME 10x80 6972

Facility

$7,675.00

Hospital Charge Code	270637764
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$1,857.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

STENT WAVEMAX 8x28mm 14549-01

Facility

$4,960.00

Hospital Charge Code	270635420V
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$1,200.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$992.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

STENT WAVEMAX 8x28mm 14549-01

Facility

$4,960.00

Hospital Charge Code	270635420
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$1,200.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$992.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

STENT WAVEMAX 8x28mm 14549-01

Facility

$4,960.00

Hospital Charge Code	270635420V
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,480.00
Rate for Payer: Aetna Commercial	$1,488.00
Rate for Payer: Aetna Medicare Advantage	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$992.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,264.80
Rate for Payer: Cigna Commercial	$2,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

STENT WAVEMAX 8x28mm 14549-01

Facility

$4,960.00

Hospital Charge Code	270635420
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,480.00
Rate for Payer: Aetna Commercial	$1,488.00
Rate for Payer: Aetna Medicare Advantage	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$992.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,264.80
Rate for Payer: Cigna Commercial	$2,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

STENT WAVEMAX 9x28x75 1455001

Facility

$4,960.00

Hospital Charge Code	270634995
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,480.00
Rate for Payer: Aetna Commercial	$1,488.00
Rate for Payer: Aetna Medicare Advantage	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$992.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,264.80
Rate for Payer: Cigna Commercial	$2,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

STENT WAVEMAX 9x28x75 1455001

Facility

$4,960.00

Hospital Charge Code	270634995V
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,480.00
Rate for Payer: Aetna Commercial	$1,488.00
Rate for Payer: Aetna Medicare Advantage	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$992.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,264.80
Rate for Payer: Cigna Commercial	$2,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

Know your out-of-pocket cost for care.

All Charges