Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLON VOY NC 3.0x15 101175415

Facility

$1,175.00

Hospital Charge Code	270643188C
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$352.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

BALLON VOY NC 3.0x15 101175415

Facility

$1,175.00

Hospital Charge Code	270643188C
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

BALLON VOY NC 3.0x20 101175420

Facility

$1,275.00

Hospital Charge Code	270643192C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY NC 3.0x20 101175420

Facility

$1,275.00

Hospital Charge Code	270643192C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY NC 3.5x15 101175615

Facility

$1,275.00

Hospital Charge Code	270643190C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY NC 3.5x15 101175615

Facility

$1,275.00

Hospital Charge Code	270643190C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY NC 3.5x20 101175620

Facility

$1,275.00

Hospital Charge Code	270643193C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY NC 3.5x20 101175620

Facility

$1,275.00

Hospital Charge Code	270643193C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY OTW 2.0x8 100943908

Facility

$10,275.00

Hospital Charge Code	270643794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.25
Max. Negotiated Rate	$2,486.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.25

BALLON VOY OTW 2.0x8 100943908

Facility

$10,275.00

Hospital Charge Code	270643794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.25
Max. Negotiated Rate	$5,137.50
Rate for Payer: Aetna Commercial	$3,082.50
Rate for Payer: Aetna Medicare Advantage	$3,082.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,620.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,620.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,620.12
Rate for Payer: Cigna Commercial	$5,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.25

BALLON VOYR RX 1.5x12 10113912

Facility

$1,275.00

Hospital Charge Code	270643195C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOYR RX 1.5x12 10113912

Facility

$1,275.00

Hospital Charge Code	270643195C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY RX 2.5x15 101139415

Facility

$1,275.00

Hospital Charge Code	270643200C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY RX 2.5x15 101139415

Facility

$1,275.00

Hospital Charge Code	270643200C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY RX 3.0x20 101139620

Facility

$1,275.00

Hospital Charge Code	270643206C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON VOY RX 3.0x20 101139620

Facility

$1,275.00

Hospital Charge Code	270643206C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLON WALRUS GUIDE .087 95CM

Facility

$8,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270694053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

BALLON WALRUS GUIDE .087 95CM

Facility

$8,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270694053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$2,625.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

BALLOON 12-15MM 75CM

Facility

$1,538.70

Service Code	HCPCS C1726
Hospital Charge Code	270665632
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$769.35
Rate for Payer: Aetna Commercial	$461.61
Rate for Payer: Aetna Medicare Advantage	$461.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.37
Rate for Payer: Cigna Commercial	$769.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 12-15MM 75CM

Facility

$1,538.70

Service Code	HCPCS C1726
Hospital Charge Code	270665632
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$372.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 12-18MM 75CM

Facility

$1,538.70

Hospital Charge Code	270665633
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$372.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 12-18MM 75CM

Facility

$1,538.70

Hospital Charge Code	270665633
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$769.35
Rate for Payer: Aetna Commercial	$461.61
Rate for Payer: Aetna Medicare Advantage	$461.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.37
Rate for Payer: Cigna Commercial	$769.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 3.50MM X 08MM

Facility

$500.00

Hospital Charge Code	270645270
Hospital Revenue Code	279
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALLOON 3.50MM X 08MM

Facility

$500.00

Hospital Charge Code	270645270
Hospital Revenue Code	279
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

BALLOON 3 APPLICATION RADIAL

Facility

$225.60

Hospital Charge Code	270680194
Hospital Revenue Code	272
Min. Negotiated Rate	$33.84
Max. Negotiated Rate	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$33.84

Know your out-of-pocket cost for care.

All Charges