Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT ORSIRO MISSION 2.5/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700991S
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 ORSIRO MISSION 2.5/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700910S
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 ORSIRO MISSION 2.5/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700910
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 ORSIRO MISSION 2.5/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700910S
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 ORSIRO MISSION 2.5/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700910
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 ORSIRO MISSION 2.75/13

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700930S
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 ORSIRO MISSION 2.75/13

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700930S
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 ORSIRO MISSION 2.75/15

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700961S
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 ORSIRO MISSION 2.75/15

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700961S
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 ORSIRO MISSION 2.75/18

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700968S
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 ORSIRO MISSION 2.75/18

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700968S
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 ORSIRO MISSION 2.75/35

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700983S
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 ORSIRO MISSION 2.75/35

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700983S
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 ORSIRO MISSION 2.75/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700992S
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 ORSIRO MISSION 2.75/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700992S
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 ORSIRO MISSION 3.0/13

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700933S
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 ORSIRO MISSION 3.0/13

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700933S
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 ORSIRO MISSION 3.0/15 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700954S
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 ORSIRO MISSION 3.0/15 MM

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700954S
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 ORSIRO MISSION 3.0/18

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700970S
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 ORSIRO MISSION 3.0/18

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700970S
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 ORSIRO MISSION 3.0/35

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700988S
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 ORSIRO MISSION 3.0/35

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700988S
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 ORSIRO MISSION 3.0/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700993S
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 ORSIRO MISSION 3.0/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700993S
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

Know your out-of-pocket cost for care.

All Charges