Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT WSRP 8x20 6FR 75cm 71124

Facility

$5,535.45

Hospital Charge Code	270633141V
Hospital Revenue Code	278
Min. Negotiated Rate	$830.32
Max. Negotiated Rate	$2,767.72
Rate for Payer: Aetna Commercial	$1,660.63
Rate for Payer: Aetna Medicare Advantage	$1,660.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,411.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,411.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,107.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,411.54
Rate for Payer: Cigna Commercial	$2,767.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,339.58
Rate for Payer: Qualcare PPO/HMO/WC	$830.32

STENT XACT CAR 10-8X40 8209601

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270643629C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAR 10-8X40 8209601

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270643629C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTD 8X30 8209201

Facility

$12,225.00

Service Code	HCPCS C1876
Hospital Charge Code	270643628C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,833.75
Max. Negotiated Rate	$6,112.50
Rate for Payer: Aetna Commercial	$3,667.50
Rate for Payer: Aetna Medicare Advantage	$3,667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,117.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,117.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,117.38
Rate for Payer: Cigna Commercial	$6,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,958.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,833.75

STENT XACT CAROTD 8X30 8209201

Facility

$12,225.00

Service Code	HCPCS C1876
Hospital Charge Code	270643628C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,833.75
Max. Negotiated Rate	$2,958.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,958.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,833.75

STENT XACT CAROTID 10-10 30MM

Facility

$10,250.00

Hospital Charge Code	270644530C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 10-10 30MM

Facility

$10,250.00

Hospital Charge Code	270644530C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 10-8 30MM

Facility

$10,250.00

Hospital Charge Code	270644100C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 10-8 30MM

Facility

$10,250.00

Hospital Charge Code	270644100C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 7X30MM

Facility

$10,250.00

Hospital Charge Code	270643951C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 7X30MM

Facility

$10,250.00

Hospital Charge Code	270643951C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 8-6 30MM

Facility

$10,250.00

Hospital Charge Code	270644097C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 8-6 30MM

Facility

$10,250.00

Hospital Charge Code	270644097C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 8-6 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644098C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 8-6 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644098C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 9-7 30MM

Facility

$10,250.00

Hospital Charge Code	270643746C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 9-7 30MM

Facility

$10,250.00

Hospital Charge Code	270643746C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 9-7 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644099C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,075.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XACT CAROTID 9-7 40MM

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270644099C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336V
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$2,976.00
Rate for Payer: Aetna Commercial	$1,785.60
Rate for Payer: Aetna Medicare Advantage	$1,785.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.76
Rate for Payer: Cigna Commercial	$2,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 7x120mm 1486405

Facility

$5,952.00

Hospital Charge Code	270635336V
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$2,976.00
Rate for Payer: Aetna Commercial	$1,785.60
Rate for Payer: Aetna Medicare Advantage	$1,785.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.76
Rate for Payer: Cigna Commercial	$2,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 8x40 80cm 1487001

Facility

$5,952.00

Hospital Charge Code	270634996V
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

STENT XCEED 8x40 80cm 1487001

Facility

$5,952.00

Hospital Charge Code	270634996
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$1,440.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.38
Rate for Payer: Qualcare PPO/HMO/WC	$892.80

Know your out-of-pocket cost for care.

All Charges