Heights University Hospital

All Charges

Charge

Type

Setting

Price

STENT ORSIRO MISSION 4.0/35

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700990S
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 4.0/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700995S
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 4.0/40

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700995S
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 4.0/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700925S
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 4.0/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700925S
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 OTRA PRO CRD PG2980BPS

Facility

$6,944.00

Hospital Charge Code	270625964V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$3,472.00
Rate for Payer: Aetna Commercial	$2,083.20
Rate for Payer: Aetna Medicare Advantage	$2,083.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.72
Rate for Payer: Cigna Commercial	$3,472.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

STENT OTRA PRO CRD PG2980BPS

Facility

$6,944.00

Hospital Charge Code	270625964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$3,472.00
Rate for Payer: Aetna Commercial	$2,083.20
Rate for Payer: Aetna Medicare Advantage	$2,083.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.72
Rate for Payer: Cigna Commercial	$3,472.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

STENT OTRA PRO CRD PG2980BPS

Facility

$6,944.00

Hospital Charge Code	270625964V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$1,680.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

STENT OTRA PRO CRD PG2980BPS

Facility

$6,944.00

Hospital Charge Code	270625964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$1,680.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

STENT OVATION IX 14 X100 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689530
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$8,548.50
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 14 X100 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689530
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 18X 120 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270691626
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$8,548.50
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 18X 120 MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270691626
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 22 X 100 MMST

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689531
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT OVATION IX 22 X 100 MMST

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270689531
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Aetna Commercial	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X120X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683560N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X20X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683559
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X40X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683562N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X40X180

Facility

$1,047.40

Service Code	HCPCS C1876
Hospital Charge Code	270683562
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$314.22
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Know your out-of-pocket cost for care.

All Charges