Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT XIENCE ALPINE 4X38MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270676042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 4x8MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270676035
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE ALPINE 4x8MM

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270676035
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT XIENCE NANO 2.25X12MM

Facility

$7,750.00

Hospital Charge Code	270645873C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X12MM

Facility

$7,750.00

Hospital Charge Code	270645873C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X15MM

Facility

$7,750.00

Hospital Charge Code	270645874C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X15MM

Facility

$7,750.00

Hospital Charge Code	270645874C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X18MM

Facility

$7,750.00

Hospital Charge Code	270645875C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X18MM

Facility

$7,750.00

Hospital Charge Code	270645875C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X23MM

Facility

$7,750.00

Hospital Charge Code	270645876C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X23MM

Facility

$7,750.00

Hospital Charge Code	270645876C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X28MM

Facility

$7,750.00

Hospital Charge Code	270645877C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X28MM

Facility

$7,750.00

Hospital Charge Code	270645877C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X8MM

Facility

$7,750.00

Hospital Charge Code	270645872C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE NANO 2.25X8MM

Facility

$7,750.00

Hospital Charge Code	270645872C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT XIENCE PRIME 1011734-33

Facility

$16,294.37

Hospital Charge Code	270647336C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$8,147.19
Rate for Payer: Aetna Commercial	$4,888.31
Rate for Payer: Aetna Medicare Advantage	$4,888.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.06
Rate for Payer: Cigna Commercial	$8,147.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE PRIME 1011734-33

Facility

$16,294.37

Hospital Charge Code	270647336C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$3,943.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE PRIME 2.25x28mm

Facility

$7,975.00

Hospital Charge Code	270647325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT XIENCE PRIME 2.25x28mm

Facility

$7,975.00

Hospital Charge Code	270647325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT XIENCE PRIME 2.5MMX33MM

Facility

$16,294.37

Hospital Charge Code	270647327C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$3,943.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE PRIME 2.5MMX33MM

Facility

$16,294.37

Hospital Charge Code	270647327C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$8,147.19
Rate for Payer: Aetna Commercial	$4,888.31
Rate for Payer: Aetna Medicare Advantage	$4,888.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.06
Rate for Payer: Cigna Commercial	$8,147.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE PRIME 2.5MMX38MM

Facility

$16,294.37

Hospital Charge Code	270647328C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$3,943.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE PRIME 2.5MMX38MM

Facility

$16,294.37

Hospital Charge Code	270647328C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.16
Max. Negotiated Rate	$8,147.19
Rate for Payer: Aetna Commercial	$4,888.31
Rate for Payer: Aetna Medicare Advantage	$4,888.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,258.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.06
Rate for Payer: Cigna Commercial	$8,147.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.16

STENT XIENCE PRIME 2.5x28mm

Facility

$7,975.00

Hospital Charge Code	270647326
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT XIENCE PRIME 2.5x28mm

Facility

$7,975.00

Hospital Charge Code	270647326
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Know your out-of-pocket cost for care.

All Charges