Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON 3 APPLICATION RADIAL

Facility

$225.60

Hospital Charge Code	270680194
Hospital Revenue Code	272
Min. Negotiated Rate	$29.33
Max. Negotiated Rate	$112.80
Rate for Payer: Aetna Commercial	$67.68
Rate for Payer: Aetna Medicare Advantage	$67.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.53
Rate for Payer: Cigna Commercial	$112.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.33
Rate for Payer: Oxford Commercial	$112.80
Rate for Payer: Qualcare PPO/HMO/WC	$33.84
Rate for Payer: UnitedHealthcare Commercial	$112.80

BALLOON 3 APPLICATOR LINEAR

Facility

$323.00

Hospital Charge Code	270680193
Hospital Revenue Code	272
Min. Negotiated Rate	$41.99
Max. Negotiated Rate	$161.50
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare Advantage	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.36
Rate for Payer: Cigna Commercial	$161.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.99
Rate for Payer: Oxford Commercial	$161.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.45
Rate for Payer: UnitedHealthcare Commercial	$161.50

BALLOON 3 APPLICATOR LINEAR

Facility

$323.00

Hospital Charge Code	270680193
Hospital Revenue Code	272
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$48.45
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

BALLOON 40 12 X 40 CM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690306
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON 40 12 X 40 CM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690306
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON 5x100x135 3903250101

Facility

$2,225.00

Hospital Charge Code	270637615V
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$667.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

BALLOON 5x100x135 3903250101

Facility

$2,225.00

Hospital Charge Code	270637615V
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$538.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

BALLOON 6x100x135 3903260101

Facility

$2,325.00

Hospital Charge Code	270638408V
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$562.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON 6x100x135 3903260101

Facility

$2,325.00

Hospital Charge Code	270638408V
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$1,162.50
Rate for Payer: Aetna Commercial	$697.50
Rate for Payer: Aetna Medicare Advantage	$697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.88
Rate for Payer: Cigna Commercial	$1,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON 6x20x80 3903160208

Facility

$2,325.00

Hospital Charge Code	270637627V
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$562.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON 6x20x80 3903160208

Facility

$2,325.00

Hospital Charge Code	270637627V
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$1,162.50
Rate for Payer: Aetna Commercial	$697.50
Rate for Payer: Aetna Medicare Advantage	$697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.88
Rate for Payer: Cigna Commercial	$1,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662264
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$759.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662264
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$1,570.00
Rate for Payer: Aetna Commercial	$942.00
Rate for Payer: Aetna Medicare Advantage	$942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.70
Rate for Payer: Cigna Commercial	$1,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662265
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$759.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662265
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$1,570.00
Rate for Payer: Aetna Commercial	$942.00
Rate for Payer: Aetna Medicare Advantage	$942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.70
Rate for Payer: Cigna Commercial	$1,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ADANTE 4.0x40 2021640

Facility

$1,875.00

Hospital Charge Code	270631409V
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON ADANTE 4.0x40 2021640

Facility

$1,875.00

Hospital Charge Code	270631409V
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON ADANTE 4.0x40 2021640

Facility

$1,860.00

Hospital Charge Code	270631409
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$930.00
Rate for Payer: Aetna Commercial	$558.00
Rate for Payer: Aetna Medicare Advantage	$558.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$474.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$474.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$474.30
Rate for Payer: Cigna Commercial	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.12
Rate for Payer: Qualcare PPO/HMO/WC	$279.00

BALLOON ADANTE 4.0x40 2021640

Facility

$1,860.00

Hospital Charge Code	270631409
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$450.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.12
Rate for Payer: Qualcare PPO/HMO/WC	$279.00

BALLOON ADMIRAL EXTR 10x40

Facility

$1,650.00

Hospital Charge Code	270639026V
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$495.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

BALLOON ADMIRAL EXTR 10x40

Facility

$1,650.00

Hospital Charge Code	270639026V
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

BALLOON ADMIRAL EXTR 4x20

Facility

$1,700.00

Hospital Charge Code	270639024V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

BALLOON ADMIRAL EXTR 4x20

Facility

$1,700.00

Hospital Charge Code	270639024V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

BALLOON ADMIRAL EXTR 7x40

Facility

$1,700.00

Hospital Charge Code	270639028V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

BALLOON ADMIRAL EXTR 7x40

Facility

$1,700.00

Hospital Charge Code	270639028V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

Know your out-of-pocket cost for care.

All Charges