Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT DE ORSIRO MISSION 2.5/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700948S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION2.75/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700963S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION2.75/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700963S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION2.75/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700953S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION2.75/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700953S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION2.75/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700945S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION2.75/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700945S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.0/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700962S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.0/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700962S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.0/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700952S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.0/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700952S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.0/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700943S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.0/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700943S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.5/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700960S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.5/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700960S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.5/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700951S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.5/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700951S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.5/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700941S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 3.5/30

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700941S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 4.0/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700958S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 4.0/22

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700958S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 4.0/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700950S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DE ORSIRO MISSION 4.0/26

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700950S
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENT DOUBLE PGT 5X24CM

Facility

$1,104.85

Hospital Charge Code	270604623
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$331.45
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

STENT DOUBLE PGT 5X24CM

Facility

$1,104.85

Hospital Charge Code	270604623
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$267.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

Know your out-of-pocket cost for care.

All Charges